Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) has been increasingly offered to older adults with hematologic malignancies. However, optimal methods to determine fitness for alloHCT have yet to be defined. We evaluated the ability of a comprehensive geriatric assessment (CGA) to predict post-alloHCT outcomes in a single-center prospective cohort study of patients aged 50 and older. Outcomes included overall survival (OS), progression-free survival (PFS), and non-relapse mortality (NRM). A total of 148 patients were included, with median age 62 years (range 50-76). In multivariate regression analysis, several CGA measures of functional status were predictive of post-alloHCT outcomes, after adjusting for traditional prognostic factors. Any deficit in Instrumental Activities of Daily Living (IADL) was associated with inferior OS (hazard ratio [HR] 1.81, 95% confidence interval [CI] 1.07-3.08, p=0.03) and PFS (HR 1.85, 95% CI 1.15-2.99, p=0.01). Medical Outcomes Study Physical Health scale (MOS-PH) score <85 was associated with inferior OS (HR 1.96, 95% CI 1.13-3.40, p=0.02), PFS (HR 1.75, 95% CI 1.07-2.88, p=0.03), and increased NRM (subdistribution HR 2.57, 95% CI 1.12-5.92, p=0.03). MOS-PH was also associated with the number of non-hematologic grade =3 adverse events within the first 100 days after alloHCT (rate ratio 1.61, 95% CI 1.04-2.49, p=0.03). These findings support previous work suggesting that IADL is an important prognostic tool prior to alloHCT. MOS-PH is newly identified as an additional metric to identify older patients at higher risk of poor post-alloHCT outcomes, including toxicity and NRM.

View details for DOI 10.1016/j.bbmt.2019.08.022

View details for PubMedID 31493541