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Clinical Trial
. 2020 Jan;26(1):189-196.
doi: 10.1016/j.bbmt.2019.08.022. Epub 2019 Sep 5.

Functional Status as Measured by Geriatric Assessment Predicts Inferior Survival in Older Allogeneic Hematopoietic Cell Transplantation Recipients

Li-Wen Huang  1 , Ying Sheng  2 , Charalambos Andreadis  1 , Aaron C Logan  1 , Gabriel N Mannis  3 , Catherine C Smith  1 , Karin M L Gaensler  1 , Thomas G Martin  1 , Lloyd E Damon  1 , Michael A Steinman  4 , Chiung-Yu Huang  2 , Rebecca L Olin  5
Affiliations
Clinical Trial

Functional Status as Measured by Geriatric Assessment Predicts Inferior Survival in Older Allogeneic Hematopoietic Cell Transplantation Recipients

Li-Wen Huang et al. Biol Blood Marrow Transplant. 2020 Jan.

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 age 50 years and older. Outcomes included overall survival (OS), progression-free survival (PFS), and nonrelapse mortality (NRM). A total of 148 patients were included, with a median age of 62 years (range, 50 to 76 years). 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 to 3.08; P = .03) and PFS (HR, 1.85; 95% CI, 1.15 to 2.99; P = .01). A Medical Outcomes Study Physical Health scale (MOS-PH) score <85 was associated with inferior OS (HR, 1.96; 95% CI, 1.13 to 3.40; P = .02), PFS (HR, 1.75; 95% CI, 1.07 to 2.88; P = .03), and increased NRM (subdistribution HR, 2.57; 95% CI, 1.12 to 5.92; P = .03). MOS-PH score 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 to 2.49; P = .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.

Keywords: Allogeneic transplantation; Functional status; Geriatric assessment.

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Conflict of interest statement

Conflict of interest: There are no relevant conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves for overall survival by A) Instrumental Activities of Daily Living (IADL), B) Medical Outcomes Study Physical Health score (MOS-PH), and C) age group. IADL deficits and MOS-PH score <85 were associated with inferior overall survival.
Figure 2.
Figure 2.
Kaplan-Meier curves for progression-free survival by A) Instrumental Activities of Daily Living (IADL), B) Medical Outcomes Study Physical Health score (MOS-PH), and C) age group. IADL deficits and MOS-PH score <85 were associated with inferior progression-free survival.
See this image and copyright information in PMC

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