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Multicenter Study
. 2014 Sep;20(9):1341-8.
doi: 10.1016/j.bbmt.2014.05.001. Epub 2014 May 9.

Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease

Areej El-Jawahri  1 , Joseph Pidala  2 , Yoshi Inamoto  3 , Xiaoyu Chai  3 , Nandita Khera  4 , William A Wood  5 , Corey Cutler  6 , Mukta Arora  7 , Paul A Carpenter  3 , Jeanne Palmer  8 , Mary Flowers  3 , Daniel Weisdorf  7 , Steven Pavletic  9 , Samantha Jaglowski  10 , Madan Jagasia  11 , Stephanie J Lee  3 , Yi-Bin Chen  12
Affiliations
Multicenter Study

Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease

Areej El-Jawahri et al. Biol Blood Marrow Transplant. 2014 Sep.

Abstract

Although older patients undergoing allogeneic hematopoietic stem cell transplantation (HCT) may experience higher morbidity, the impact of chronic graft-versus-host disease (GVHD) on quality of life (QOL) and survival outcomes for older compared with younger patients is currently unknown. We utilized data of patients with moderate or severe chronic GVHD (N = 522, 1661 follow-up visits, a total of 2183 visits) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between age group (adolescent and young adult, "AYA," 18 to 40 years; "middle-aged," 41 to 59 years; and "older," ≥ 60 years) and QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]), physical functioning (Human Activity Profile [HAP]), functional status (2-minute walk test [2MWT]), nonrelapse mortality, and overall survival. Because of multiple testing, P values < .01 were considered significant. This study included 115 (22%) AYA, 279 (53%) middle-aged, and 128 (25%) older patients with moderate (58%) or severe (42%) chronic GVHD. Despite more physical limitations in older patients as measured by worse functional status (shorter 2MWT [P < .001] and lower HAP scores [P < .001]) relative to AYA and middle-aged patients, older patients reported better QOL (FACT-BMT, P = .004) compared with middle-aged patients and similar to AYA patients (P = .99). Nonrelapse mortality and overall survival were similar between the age groups. Therefore, despite higher physical and functional limitations, older patients who are selected to undergo HSCT and survive long enough to develop moderate or severe chronic GVHD have preserved QOL and similar overall survival and nonrelapse mortality when compared with younger patients. Therefore, we did not find evidence that older age is associated with worse outcomes in patients with moderate or severe chronic GVHD.

Keywords: Age; Chronic graft-versus-host disease; Functional status; Quality-of-life.

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Figures

Figure 1
Figure 1. QOL, psychological symptoms, physical fitness, and functional status comparison between age groups at study enrollment
The bar height represents the medians in each group. The p-values reported reflect the overall comparison across all age groups.
Figure 2
Figure 2
(A) Overall survival and (B) Cumulative incidence of non-relapse mortality
See this image and copyright information in PMC

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