Journal
JOURNAL OF GERIATRIC ONCOLOGY
Volume 12, Issue 4, Pages 585-591Publisher
ELSEVIER
DOI: 10.1016/j.jgo.2020.10.019
Keywords
Autologous; Hematopoietic cell transplant; Older adults; Geriatric assessment
Categories
Funding
- Merck
- iTeos
- Celgene/Bristol-Myers Squibb
- Kite Pharmaceuticals/Gilead
- Morphosys
- Novartis
- Miltenyi Biotec
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This study found that older patients who underwent autologous hematopoietic stem cell transplant (autoHCT) guided by a geriatric assessment achieved good treatment outcomes, especially those who were deferred but ultimately received autoHCT. Poor grip strength and performance status were associated with worse post-transplant survival rates.
Background: Autologous hematopoietic stem cell transplant (autoHCT) is a mainstay of treatment for multiple myeloma and non-Hodgkin lymphoma but is underutilized in older adults. We investigated the association of vulnerabilities identified by a geriatric assessment (GA)-guided multidisciplinary clinic (MDC) on the receipt of autoHCT and evaluated its ability to predict outcomes in older autoHCT candidates. Methods: Patients 50+ years received GA-informed optimization recommendations: 'decline' if unlikely to realize benefits of autoHCT, 'defer' if optimization necessary before autoHCT, and 'proceed' if autoHCT could proceed without delay. We compared characteristics and outcomes of autoHCT recipients (n = 62) to non-autoHCT patients (n = 29) and evaluated GA deficits on outcomes. Results: 91 patients were evaluated; the MDC recommendation was 'decline' for 5 (6%), 'defer' for 25 (27%), and 'proceed' for 61 (67%). AutoHCT recipients had fewer GA-rated impairments relative to non-autoHCT patients, as did patients with a 'proceed' recommendation relative to 'defer'. Among autoHCT recipients, 1-year and 3-year non-relapse morality (NRM) was 0% and 5%, and there was no difference in length of hospitalization, readmission rate, or mortality after transplant by MDC recommendation. Frail grip strength and poor performance status were associated with inferior post-autoHCT progression-free survival and overall survival. Conclusions: Patients pursuing autoHCT after MDC-directed optimization achieved excellent outcomes, including patients deferred but ultimately receiving autoHCT. GA-identified functional deficits, especially frail grip strength, may improve risk stratification in older autoHCT candidates. Employing a GA earlier in the disease trajectory to inform early referral to an MDC may increase autoHCT safety and utilization in older patients. (c) 2020 Elsevier Ltd. All rights reserved.
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