Listen to Thy Patient: Poor Quality of Life (QoL) Reported by Older Adults Prior to Allogeneic Stem Cell Transplantation (allo-HCT) Is Independently Associated with Worse Transplant Outcomes

Abstract

and increased physical activity (ORs 0.8-0.9; p 5 0.04-0.07) were associated with a lower likelihood of requiring dyslipidemia or diabetes medications. Obesity was significantly associated with an increased likelihood of all 3 metabolic conditions (ORs 2.6-2.9; p\0.05). A family history of CV disease also remained a significant risk factor for most serious and related CV outcomes post-transplant. Conclusions: HCT survivors have a high burden of metabolic conditions (hypertension, dyslipidemia, diabetes, and obesity) known to predispose towards more serious CV conditions following HCT. A less healthy diet, decreased physical activity, and obesity were associated with these conditions, suggesting potential interventions that may reduce CV disease among HCT survivors. Introduction: Concern regarding baseline health status and ability to predict tolerance have been major factors limiting application of allo-HCT to older adults. Standard health status assessment tools such as comorbidity and performance status (PS), have uncertain prognostic significance in older transplant patients. Little is known about health related QoL in older adults undergoing allo-HCT, and how patient perceived physical and mental functioning relates to transplant outcomes. Methods: We performed a prospective comprehensive geriatric assessment (CGA) on patients $50 years old prior to allo-HCT. As part of CGA, 163 patients completed a Medical Outcomes Study Short Form (SF-36), an extensively validated health related QoL questionnaire. Physical and mental component summary measures (PCS and MCS) were compared to population age group norms. Kaplan-Meier and Cox Regression analyses were used to determine the association between PCS and MCS as continuous variables to nonrelapse mortality (NRM) and OS. To estimate effect size, we modeled the hazard ratio (HR) for scores \40, which represents 1SD below population norm and approximated sample median. Results: Median age was 58; 39% were .60. AML or MDS was the most common diagnosis (53%); 48% had active disease (not in remission) prior to allo-HCT. Donor sources were matched sibling (45%), MUD (36%), mismatch/cord (19%). Conditioning was primarily reduced intensity (75% vs 25% ablative). 44% had an HCT-CI $3; 36% had ECOG PS $1. Pre-transplant SF-36 scores demonstrated significantly worse physical and mental health compared to age group matched controls (Table 1). Lower PCS and MCS showed borderline association with increased NRM (P 5 .076 for PCS; P 5 .05 for MCS). A stronger association existed for inferior survival for lower PCS (P 5 .002) and MCS (P 5 .014), which remained significant when controlling for age, disease risk, comorbidity, and PS. PCS and MCS scores \40 reduced OS by approximately 50% (HR 1.5, 95% CI 1.03-2.3, P 5 .03 for PCS; HR 1.47, 95% CI .97-2.2, P 5 .07 for MCS). Conclusions: Self reported physical and mental health impairments are frequent and substantial in older adults prior to allo-HCT. Lower physical and mental health functioning independently conferred inferior OS. Patien...