Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

Meagan V. Lew; Yi Ren; Yen P. Lowder; Sharareh Siamakpour-Reihani; Sendhilnathan Ramalingam; Kristi M. Romero; J Thompson; Lauren M. Bohannon; Jackie McIntyre; Helen Tang; Jolien Van Opstal; E Johnson; H Cohen; DAVID BARTLETT; Amy M. Pastva; Miriam Morey; K Hall; Patrick Smith; Katherine B. Peters; Sarah Kelleher; Tamara J. Somers; Sophia K. Smith; Paul E. Wischmeyer; Pao-Hwa Lin; William A. Wood; Glynnis Thorpe; Kerry Minor; Kristi Wiggins; Therese Hennig; Tanya Helms; Renee Welch; B Matthews; JoAnn Liu; Jill Burleson; Thomas Aberant; Ashley K. Engemann; Bethany Henshall; Maurisa Darby; Christina Proch; Michelle Dellascio; Alyssa Pittman; Jacob Suminguit; Taewoong Choi; Cristina Gasparetto; Gwynn D. Long; Richard D. Lopez; Stefanie Sarantopoulos; Mitchell E. Horwitz; Nelson J. Chao; Anthony D. Sung

doi:10.1016/j.jtct.2022.05.018

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Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

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Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

Meagan V. Lew, Yi Ren, Yen P. Lowder, Sharareh Siamakpour-Reihani, Sendhilnathan Ramalingam, Kristi M. Romero, J Thompson, Lauren M. Bohannon, Jackie McIntyre, Helen Tang, …

Transplantation and cellular therapy, Vol.28(8), pp.498.E1-498.E9

01/05/2022

DOI: https://doi.org/10.1016/j.jtct.2022.05.018

Abstract

Allogeneic hematopoietic stem cell transplantation

Functional domains

Geriatric assessment

Transplantation outcome

Treatment-related mortality

•Geriatric assessment can identify impairments in hematopoietic cell transplantation (HCT) candidates.•Impairments can be found in older (>60 years) as well as younger (18 to 59 years) HCT candidates.•Identifying impairments can facilitate referral and resolution of impairments.•Geriatric assessment may be useful in HCT candidates of all ages. Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative treatment for both malignant and nonmalignant hematologic diseases; however, reported rates of treatment-related mortality approach 30%. Outcomes are worse in patients who begin HCT with functional impairments. To detect such impairments, a geriatric assessment (GA) is recommended in adults age ≥65 years. Younger HCT candidates also may be impaired because of chemotherapy regimens pre-HCT. Therefore, we hypothesized that GA can be beneficial for adult patients of all ages and subsequently created a clinical pretransplantation optimization program to assess all HCT candidates using a modified GA. One-hundred fifty-seven patients were evaluated in 4 functional domains— physical, cognitive, nutritional, and psychological—at 2 time points prior to HCT—new patient evaluation (NPE) and sign-off (SO)—between October 2017 and January 2020. At NPE, 80.9% of the patients had at least 1 domain with a functional impairment, and physical (P = .006), cognitive (P = .04), and psychological (P = .04) impairments were associated with an increased likelihood of not proceeding to HCT. In addition, patients age 18 to 39 years were more likely than older patients to have a physical function impairment (P = .001). Between NPE and SO, 51.9% of the patients had resolution of 1 or more impairments, and nutritional impairment at SO was predictive of worse overall survival (P = .01). Our study shows that GA can identify functional impairments in patients of all ages. Early identification of impairments could facilitate referrals to supportive care and resolution of impairments prior to HCT, suggesting that GA could be recommended for HCT candidates of all ages.

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Title: Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years
Creators: Meagan V. Lew - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Yi Ren - Duke Cancer Institute Biostatistics Shared Resources, Durham, North Carolina
Yen P. Lowder - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Sharareh Siamakpour-Reihani - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Sendhilnathan Ramalingam - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Kristi M. Romero - Duke University School of Medicine, Durham, North Carolina
J Thompson - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Lauren M. Bohannon - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Jackie McIntyre - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Helen Tang - Duke University School of Medicine, Durham, North Carolina
Jolien Van Opstal - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
E Johnson - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
H Cohen - Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
DAVID BARTLETT
Amy M. Pastva - Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
Miriam Morey - Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
K Hall - Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
Patrick Smith - Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
Katherine B. Peters - Departments of Neurology and Neurosurgery, The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
Sarah Kelleher - Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
Tamara J. Somers - Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
Sophia K. Smith - School of Nursing, Duke University Medical Center, Durham, North Carolina
Paul E. Wischmeyer - Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
Pao-Hwa Lin - Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
William A. Wood - Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Glynnis Thorpe - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Kerry Minor - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Kristi Wiggins - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Therese Hennig - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Tanya Helms - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Renee Welch - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
B Matthews - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
JoAnn Liu - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Jill Burleson - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Thomas Aberant - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Ashley K. Engemann - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Bethany Henshall - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Maurisa Darby - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Christina Proch - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Michelle Dellascio - Duke Health Department of Physical Therapy and Occupational Therapy, Durham, North Carolina
Alyssa Pittman - Duke Health Department of Physical Therapy and Occupational Therapy, Durham, North Carolina
Jacob Suminguit - University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Taewoong Choi - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Cristina Gasparetto - Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Gwynn D. Long - Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Richard D. Lopez - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Stefanie Sarantopoulos - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Mitchell E. Horwitz - Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Nelson J. Chao - Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University Medical Center, Durham, North Carolina
Anthony D. Sung - Division of Hematologic Malignancies and Cellular Therapy, Duke University Medical Center, Durham, North Carolina
Publication Details: Transplantation and cellular therapy, Vol.28(8), pp.498.E1-498.E9
Publisher: Elsevier Inc
Date published: 01/05/2022
Identifiers: 99667166602346
Academic Unit: School of Biosciences
Language: English
Resource Type: Journal article
SDG (Scopus 2023): SDG 3

Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years

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