Hematopoietic stem cell transplant (HSCT) is a common treatment for many patients with hematologic malignancies and is associated with good long-term outcomes, including potential cure. However, this treatment approach can also be associated with significant morbidity. At the Transplantation and Cellular Therapy annual meeting, Benjamin Derman, MD (University of Chicago, Illinois, United States), presented results suggesting patients over the age of 70 years should undergo a geriatric assessment prior to transplant to ensure best outcomes. The study reported results from 91 patients over the age of 70 who were evaluated in a geriatric assessment-guided multidisciplinary clinic (GA-MDC) prior to HSCT at the University of Chicago between 2015 and 2018. The GA-MDC included cognitive and strength tests, as well as evaluation by a multidisciplinary team.
Of the 91 patients evaluated, 5 (6%) received a decline recommendation, ie that they should not receive a transplant, 25 (27%) received a defer recommendation, and 61 (67%) received a recommendation to proceed. Patients who received a recommendation to defer transplant were more likely to have frail 4-meter walks, had more restrictions on activities of daily living, higher rates of depression, lower Karnofsky performance scores, and higher rates of polypharmacy compared to patients who received a proceed recommendation. All patients included in this analysis had low rates of treatment-related mortality, with 1-year rates between 0% and 1%.
HSCT was associated with improved outcomes, with an estimated 3-year overall survival (OS) of 76% in patients receiving transplant compared to 44% in patients who did not undergo transplant (P = .0004). Among patients receiving a deferral recommendation who ultimately underwent HSCT, the 1-year OS was 92%. Those who did not go on to receive transplant had a 1-year OS of 60%, though this difference was not statistically significant due to the small sample size.
Dr Derman concluded that patients over the age of 70 who are being considered for HSCT should be carefully evaluated by a multidisciplinary team for risk factors associated with older age in order to determine if transplant is the best treatment option. However, this approach will likely need to be formalized before it can be implemented in a large scale in transplant centers across the country.
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