Impact of geriatric vulnerabilities on allogeneic hematopoietic cell transplantation outcomes in older patients with hematologic malignancies

Abstract

Older patients are at increased risk for complications and death following allogeneic hematopoietic cell transplantation (allo-HCT). Traditional transplant-specific prognostic indices such as hematopoietic cell transplant comorbidity index (HCT-CI) may not capture all underlying geriatric vulnerabilities, and in-depth evaluation by a geriatrician prior to transplant may not always be available. We hypothesize that routine pre-transplant interdisciplinary clinical assessment may uncover prognostically important geriatric deficits. Using an institutional database of 457 adults aged 60 years and older who underwent first allo-HCT for hematological malignancies from 2010 to 2017, we examined the prognostic impact of pre-transplant deficits in geriatric domains of function, mobility, mood, medication, nutrition, and relevant biochemical markers. We found that impairment in instrumental activities of daily living (IADL) was

Impact and safety of chimeric antigen receptor T-cell therapy in older, vulnerable patients with relapsed/refractory large B-cell lymphoma

“…Importantly, we compare toxicities and outcomes of younger versus older patients who received CAR T using the Medicare coverage policy cutoff of 65 years. Multi-dimensional geriatric assessment (GA) of comorbidity, function, mobility, nutrition, mood, and medication was prospectively collected prior to CAR T by a geriatrician or by an interdisciplinary clinical provider as previously described 4 . Specifically, the comorbidity burden was defined using the Deyo/Charlson Comorbidity Index (DCI/CCI) 5 .…”

“…Specifically, the comorbidity burden was defined using the Deyo/Charlson Comorbidity Index (DCI/CCI) 5 . Functional limitation was defined by deficits in basic or instrumental activities of daily living (ADL/IADL) 4 . A waiver of authorization for retrospective collection of demographic, treatment, and survival data was obtained from the Institutional Review and Privacy Board.…”

Geriatric assessment in older patients with a hematologic malignancy: a systematic review

“…Eight studies focused on acute myeloid leukemia and/or myelodysplastic syndromes, [19][20][21][22][23][24][25]27 two on chronic lymphocytic leukemia, 28,29 13 on lymphoma, [30][31][32][33][34][35][36][37][38][39][40][41][42] seven on multiple myeloma, [42][43][44][45][46][47][48] and 15 studies included various hematologic malignancies. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The median number of domains addressed in the geriatric assessment was four (range, 2-9). These included ADL in 30 studies (68%), IADL in 37 (84%), cognition in 29 (66%), mood in 24 (55%) and objectively measured physical capacity in 20 studies (46%).…”

“…median age less than 68 years old, or more than one third of the patients younger than 65 years old); 22,27,41,43,46,48,50,58,59 these studies were assessed as not being fully representative of the target cohort of the average older patients with a hematologic malignancy. Similarly, eight studies focused on a very specific treatment 20,23,24,31,51,55,56,60 which we considered as not fully representative of our target population. Overall, the duration of follow-up was sufficient but in nine studies the followup rate was less than 90% 24,30,46 or the adequacy of followup was not reported.…”

“…Overall, the duration of follow-up was sufficient but in nine studies the followup rate was less than 90% 24,30,46 or the adequacy of followup was not reported. 27,32,33,56,57,62 There were no other quality concerns.…”