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Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis

Bone Marrow Transplantation volume 53, pages 565–575 (2018)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) in older patients requires the weighing of risks and benefits for this potentially curative treatment while facing age-related limitations. Comprehensive geriatric and quality of life (EORTC QLQ C-30) assessements (CGA/QOL) in addition to disease-specific data were obtained in 108 consecutive patients (≥60 years) pre-HCT, at day +30, +100, and +180. Median follow-up of 106 patients alive at alloHCT was 43.5 months, median age 66 years (range 60–78). Eighty-six (81.2%) had advanced disease risk at HCT and 99 (91.7%) patients received reduced intensity conditioning (RIC). Median PFS was 13.4 months with 38.3% (95% CI: 28.6–47.4) alive and in remission at 2 years; median OS was 15.6 months with 43.9% (95% CI: 34.3–53.4) alive at 2 years. Prognostic factors for PFS were: age: HR 1.084 (95% CI: 1.032–1.137, p = 0.0011); HCT-CI: HR 1.13 (95% CI: 1.001–1.274, p = 0.048); for OS: age: HR 1.08 (95% CI: 1.031–1.139, p = 0.0017), Karnofsky Index: HR 0.97 (95% CI: 0.954–0.996, p = 0.02); EORTC QLQ C–30 fatigue: HR 1.09 (95% CI: 1.004–1.185, p = 0.039); Up-and-Go: HR 3.26 (95% CI: 1.001–10.6, p = 0.049). Follow-up assessments as time-dependent covariates were highly prognostic for OS and PFS. CGA/QOL confer additional prognostic utility in older alloHCT recipients.

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Acknowledgements

This study was supported by the German Krebshilfe Fund (Grant 108467) to B.D. and J.F. The funding source had no role in the design and conduct of the study; in the collection, analysis or interpretation of data; in the reporting, preparation, or review of the manuscript; or in the decision to submit the manuscript for publication. The material of the manuscripts is original research and has not been previously published or submitted for publication elsewhere. Some of the preliminary data have been presented in an oral presentation at the EBMT Meeting 2016 in Valencia, Spain.

Author contributions

B.D., S.S., H.B., and J.F. designed the study, collected and analyzed the data and wrote the manuscript. G.I. statistically analyzed the data and wrote the manuscript.

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Authors and Affiliations

  1. Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany

    Barbara Deschler

  2. Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany

    Gabriele Ihorst

  3. Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany

    Susanne Schnitzler, Hartmut Bertz & Juergen Finke

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  1. Barbara Deschler
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Correspondence to Barbara Deschler.

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Deschler, B., Ihorst, G., Schnitzler, S. et al. Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis. Bone Marrow Transplant 53, 565–575 (2018). https://doi.org/10.1038/s41409-017-0021-4

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