Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

Lew, M.; Ren, Yi; Lowder, Yen P.; Siamakpour-Reihani, Sharareh; Ramalingam, Sendhilnathan; Romero, Kristi; Thompson, Jocelyn S.; Bohannon, Lauren M.; McIntyre, Jennifer; Tang, Helen; Opstal, Jolien Van; Johnson, Ernaya; Cohen, Harvey Jay; Bartlett, David B.; Pastva, Amy M.; Morey, Miriam C.; Hall, Katherine S.; Smith, Patrick J.; Peters, Katherine B.; Somers, Tamara J.; Kelleher, Sarah A.; Smith, Sophia K.; Wischmeyer, Paul E.; Lin, Pao-Hwa; Wood, William A.; Thorpe, Glynnis; Minor, Kerry; Wiggins, Kristi; Hennig, Therese; Helms, Tanya; Welch, Renee; Matthews, Brittany A.; Liu, JoAnn; Burleson, Jill; Aberant, Thomas; Engemann, Ashley K.; Henshall, Bethany; Darby, Maurisa; Proch, Christina; Dellascio, Michelle; Pittman, Alyssa; Suminguit, Jacob; Choi, Taewoong; Gasparetto, Cristina; Long, Gwynn D.; Lopez, Richard D.; Sarantopoulos, Stefanie; Horwitz, Mitchell E.; Chao, Nelson J.; Sung, Anthony D.

doi:10.1016/j.jtct.2022.05.018

Cited by 8 publications

(3 citation statements)

References 41 publications

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“…In HSCT, prehabilitation research is limited to small studies; however, emerging data are positive in respect to feasibility outcomes in addition to physical and psychological indices [ 28 – 31 ]. In older adults scheduled for HSCT, standardised assessments of physical frailty, geriatric assessment and patient-reported functionality assessments can be predictive of transplant outcomes including overall survival [ 32 – 37 ], non-relapse mortality [ 37 , 38 ] and hospital length of stay [ 38 – 40 ], and therefore indicate amenable targets for pre-transplant optimisation through prehabilitation. Results from our interviews also strongly support a role for psychological preparation for transplant in older adults and identify pre-transplant psychological assessment and optimisation as a research priority.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, co-morbidity assessment comprised the major focus for pre-transplant evaluation. While emerging evidence suggests a role for geriatric assessment and validated measures of physical frailty as predictive of transplant outcomes in older adults [ 32 – 40 ], these outcomes were rarely, if ever, formally incorporated into routine practice at these Irish sites. Routine integration of these outcomes into clinical care pathways would aid the development of individualised prehabilitation programmes that target priority impairments.…”

Section: Discussionmentioning

confidence: 99%

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Health professionals’ perceptions of prehabilitation before haematopoietic cell transplantation to optimise candidacy in older adults

Guinan,

Heuston,

Sheill

et al. 2024

Support Care Cancer

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Purpose Haematologic malignancies for the most part are diseases of the elderly. Haematopoietic stem cell transplantation (HSCT) remains the only potentially curative strategy for many patients but carries substantial morbidity and mortality risks, particularly in frail or co-morbid patients. Pre-transplant optimisation of key targets through prehabilitation may have significant clinical impact. Methods We utilised qualitative methodology (semi-structured interviews) to gain insights and understanding of the perceptions of medical, nursing and allied health professionals towards prehabilitation before haematopoietic cell transplantation to optimise candidacy in older adults. Thematic analysis was performed using a qualitative descriptive approach completed in duplicate by two researchers. Results Between August and October 2023, eleven health professionals participated from four large cancer centres across the island of Ireland (n = 3 consultant haematologists, n = 7 specialist haematology nurses and n = 1 senior haematology physiotherapist). Four major themes were identified. The themes comprehensive biopsychosocial care and increasing demand for transplant in older patients highlight the unique challenges impacting older adults who receive HSCT. The multimodality pathways of care theme highlights the heterogeneity of treatment pathways across different clinical sites and disease types. This has implications for the prehabilitation: logistics and benefits theme, which indicated strong support for prehabilitation but emphasised that implementation must consider national reach and context. Conclusions There is broad national multidisciplinary interest in the development of prehabilitation programmes for patients being considered for transplant. Our results will inform the development of services in this area in consideration of national reach, malignancy-specific pathways and the unique factors associated with older age.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health professionals’ perceptions of prehabilitation before haematopoietic cell transplantation to optimise candidacy in older adults

Guinan,

Heuston,

Sheill

et al. 2024

Support Care Cancer

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“…34 Not only in elderly individuals but a similar comprehensive assessment has been shown to be beneficial in younger transplant candidates who previously received multiple lines of treatment prior allo-HSCT. 36…”

Section: Role Of Transplantation In Mdsmentioning

confidence: 99%

Allogeneic stem cell transplantation for patients with myelodysplastic syndromes

2022

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Myelodysplastic syndromes (MDS) are a heterogenous group of clonal hematopoietic stem cell neoplasms primarily affecting older persons, associated with dysplastic changes of bone marrow cells, peripheral cytopenias, and various risk of leukemic transformation. Although treatment with several drugs has shown improved disease control, allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment for MDS. The number of patients receiving a transplant, as well as survival, have increased past years because of the use of reduce-intensity conditioning regimens (RIC) as well as the use of haploidentical donors for transplantation. With treatment-related mortality as main limitation, pre-transplant evaluation is essential to assess risks for this older group of patients. In a recent randomized study, allo-HSCT with RIC for patients >50 years old with higher-risk MDS demonstrated superiority in survival compared with hypomethylating agents. Genetic mutations have been shown to significantly impact treatment outcomes including after transplant. Recently, a transplant-specific risk score (which includes age, donor type, performance status, cytogenetic category, recipient's cytomegalovirus status, percentage of blasts, and platelet count) has shown superiority in transplantation outcome prediction, compared with previous scoring systems. Survival remains low for most patients with TP53 mutations and novel treatment strategies are needed, such as administration of natural killer cells post-transplant, as there is no clear evidence that maintenance therapy after transplantation can improve outcomes.

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Transplantation and Cellular Therapy for Older Adults—The MSK Approach

Lin,

Dahi,

Korc-Grodzicki

et al. 2024

Curr Hematol Malig Rep

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Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

Cited by 8 publications

References 41 publications

Health professionals’ perceptions of prehabilitation before haematopoietic cell transplantation to optimise candidacy in older adults

Health professionals’ perceptions of prehabilitation before haematopoietic cell transplantation to optimise candidacy in older adults

Allogeneic stem cell transplantation for patients with myelodysplastic syndromes

Transplantation and Cellular Therapy for Older Adults—The MSK Approach

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