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Process of allogeneic hematopoietic cell transplantation decision making for older adults

Bone Marrow Transplantation volume 51, pages 623–628 (2016)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem.

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References

  1. Gökbuget N . How I treat older patients with ALL. Blood 2013; 122: 1366–1375.

    Article  Google Scholar 

  2. Klepin HD, Rao AV, Pardee TS . Acute myeloid leukemia and myelodysplastic syndromes in older adults. J Clin Oncol 2014; 32: 2541–2552.

    Article  Google Scholar 

  3. Ustun C, Marcucci G . Emerging diagnostic and therapeutic approaches in core binding factor acute myeloid leukaemia. Curr Opin Hematol 2015; 22: 85–91.

    Article  CAS  Google Scholar 

  4. SEER Cancer Statistics Factsheets [Internet]. National Cancer Institute. Bethesda, MD; Available from http://seer.cancer.gov/statfacts/. Accessed on 30 June 2015.

  5. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF et al (eds). SEER Cancer Statistics Review, 1975-2012 [Internet]. National Cancer Institute, Bethesda, MD, 2014. Available from http://seer.cancer.gov/csr/1975_2012/. Accessed on 30 June 2015.

  6. Ustun C, Lazarus HM, Weisdorf D . To transplant or not: a dilemma for treatment of elderly AML patients in the twenty-first century. Bone Marrow Transplant 2013; 48: 1497–1505.

    Article  CAS  Google Scholar 

  7. Hahn T, McCarthy PL, Hassebroek A, Bredeson C, Gajewski JL, Hale GA et al. Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors. J Clin Oncol 2013; 31: 2437–2449.

    Article  Google Scholar 

  8. Pasquini MC, Zhu X Current uses and outcomes of hematopoietic stem cell transplantation: 2014 CIBMTR Summary Slides. Available from http://www.cibmtr.org. Accessed on 1 September 2015.

  9. Majhail NS, Tao L, Bredeson C, Davies S, Dehn J, Gajewski JL et al. Prevalence of hematopoietic cell transplant survivors in the United States. Biol Blood Marrow Transplant 2013; 19: 1498–1501.

    Article  Google Scholar 

  10. Jacoby LH, Maloy B, Cirenza E, Shelton W, Goggins T, Balint J . The basis of informed consent for BMT patients. Bone Marrow Transplant 1999; 23: 711–717.

    Article  CAS  Google Scholar 

  11. Pisu S, Caocci G, d’ Aloja E, Efficace F, Vacca A, Piras E et al. Reassessing the approach to informed consent: the case of unrelated hematopoietic stem cell transplantation in adult thalassemia patients. Philos Ethics Humanit Med 2014; 9: 13.

    Article  Google Scholar 

  12. D’Souza A, Pasquini M, Spellecy R . Is ‘informed consent’ an ‘understood consent’ in hematopoietic cell transplantation? Bone Marrow Transplant 2015; 50: 10–14.

    Article  Google Scholar 

  13. Wedding U, Röhrig B, Klippstein A, Fricke H-J, Sayer HG, Höffken K . Impairment in functional status and survival in patients with acute myeloid leukaemia. J Cancer Res Clin Oncol 2006; 132: 665–671.

    Article  Google Scholar 

  14. Walter RB, Othus M, Borthakur G, Ravandi F, Cortes JE, Pierce SA et al. Prediction of early death after induction therapy for newly diagnosed acute myeloid leukemia with pretreatment risk scores: a novel paradigm for treatment assignment. J Clin Oncol 2011; 29: 4417–4423.

    Article  Google Scholar 

  15. Muffly LS, Kocherginsky M, Stock W, Chu Q, Bishop MR, Godley LA et al. Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients. Haematologica 2014; 99: 1373–1379.

    Article  Google Scholar 

  16. Deschler B, Ihorst G, Platzbecker U, Germing U, März E, de Figuerido M et al. Parameters detected by geriatric and quality of life assessment in 195 older patients with myelodysplastic syndromes and acute myeloid leukemia are highly predictive for outcome. Haematologica 2013; 98: 208–216.

    Article  Google Scholar 

  17. Wingard JR, Majhail NS, Brazauskas R, Wang Z, Sobocinski KA, Jacobsohn D et al. Long-term survival and late deaths after allogeneic hematopoietic cell transplantation. J Clin Oncol 2011; 29: 2230–2239.

    Article  Google Scholar 

  18. Booth-Jones M, Jacobsen PB, Ransom S, Soety E . Characteristics and correlates of cognitive functioning following. Bone Marrow Transplant 2005; 36: 695–702.

    Article  CAS  Google Scholar 

  19. Rusiewicz A, DuHamel KN, Burkhalter J, Ostroff J, Winkel G, Scigliano E et al. Psychological distress in long-term survivors of hematopoietic stem cell transplantation. Psychooncology 2008; 17: 329–337.

    Article  Google Scholar 

  20. Harder H, Cornelissen JJ, Van Gool AR, Duivenvoorden HJ, Eijkenboom WMH, van den Bent MJ . Cognitive functioning and quality of life in long-term adult survivors of bone marrow transplantation. Cancer 2002; 95: 183–192.

    Article  Google Scholar 

  21. Syrjala KL, Artherholt SB, Kurland BF, Langer SL, Roth-Roemer S, Elrod JB et al. Prospective neurocognitive function over 5 years after allogeneic hematopoietic cell transplantation for cancer survivors compared with matched controls at 5 years. J Clin Oncol 2011; 29: 2397–2404.

    Article  Google Scholar 

  22. Jacobs SR, Small BJ, Booth-Jones M, Jacobsen PB, Fields KK . Changes in cognitive functioning in the year after hematopoietic stem cell transplantation. Cancer 2007; 110: 1560–1567.

    Article  Google Scholar 

  23. Syrjala KL, Dikmen S, Langer SL, Roth-Roemer S, Abrams JR . Neuropsychologic changes from before transplantation to 1 year in patients receiving myeloablative allogeneic hematopoietic cell transplant. Blood 2004; 104: 3386–3392.

    Article  CAS  Google Scholar 

  24. Sostak P, Padovan CS, Yousry TA, Ledderose G, Kolb H-J, Straube A . Prospective evaluation of neurological complications after allogeneic bone marrow transplantation. Neurology 2003; 60: 842–848.

    Article  CAS  Google Scholar 

  25. Pinquart M, Höffken K, Silbereisen RK, Wedding U . Social support and survival in patients with acute myeloid leukaemia. Support Care Cancer 2007; 15: 81–87.

    Article  Google Scholar 

  26. Khera N, Chang Y, Hashmi S, Slack J, Beebe T, Roy V et al. Financial burden in recipients of allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014; 20: 1375–1381.

    Article  Google Scholar 

  27. Khera N . Reporting and grading financial toxicity. J Clin Oncol 2014; 32: 3337–3338.

    Article  Google Scholar 

  28. De Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer 2014; 120: 3245–3253.

    Article  Google Scholar 

  29. Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL et al. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 2013; 119: 3710–3717.

    Article  Google Scholar 

  30. Arora M, Sun C, Ness K, Teh JB, Schad A, Hanby C et al. Older survivors of allogeneic hematopoietic cell transplantation (HCT) with chronic graft vs. host disease (cGvHD) demonstrate higher risk of frailty as compared with autologous hct recipients: a report from the Bone Marrow Transplant Survivor Study-2. Biol Blood Marrow Transpl 2015; 21: S72–S73.

    Article  Google Scholar 

  31. Sekeres MA, Stone RM, Zahrieh D, Neuberg D, Morrison V, De Angelo DJ et al. Decision-making and quality of life in older adults with acute myeloid leukemia or advanced myelodysplastic syndrome. Leukemia 2004; 18: 809–816.

    Article  CAS  Google Scholar 

  32. Pidala J, Anasetti C, Jim H . Quality of life after allogeneic hematopoietic cell transplantation. Blood 2009; 114: 7–19.

    Article  CAS  Google Scholar 

  33. Hamilton BK, Rybicki L, Dabney J, McLellan L, Haddad H, Foster L et al. Quality of life and outcomes in patients⩾60 years of age after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2014; 49: 1426–1431.

    Article  CAS  Google Scholar 

  34. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers MED et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA 2004; 291: 2335–2343.

    Article  CAS  Google Scholar 

  35. Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN . Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psychooncology 2009; 18: 113–127.

    Article  Google Scholar 

  36. Smith MY, Redd W, DuHamel K, Vickberg SJ, Ricketts P . Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation. J Trauma Stress 1999; 12: 485–499.

    Article  CAS  Google Scholar 

  37. DuHamel KN, Ostrof J, Ashman T, Winkel G, Mundy EA, Keane TM et al. Construct validity of the posttraumatic stress disorder checklist in cancer survivors: analyses based on two samples. Psychol Assess 2004; 16: 255–266.

    Article  Google Scholar 

  38. Lee SJ, Loberiza FR, Antin JH, Kirkpatrick T, Prokop L, Alyea EP et al. Routine screening for psychosocial distress following hematopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35: 77–83.

    Article  CAS  Google Scholar 

  39. Pidala J, Kurland B, Chai X, Majhail N, Weisdorf DJ, Pavletic S et al. Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: report on baseline data from the Chronic GVHD Consortium. Blood 2011; 117: 4651–4657.

    Article  CAS  Google Scholar 

  40. Deschler B, Binek K, Ihorst G, Marks R, Wäsch R, Bertz H et al. Prognostic factor and quality of life analysis in 160 patients aged ≥60 years with hematologic neoplasias treated with allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2010; 16: 967–975.

    Article  Google Scholar 

  41. Jim HSL, Quinn GP, Gwede CK, Cases MG, Barata A, Cessna J et al. Patient education in allogeneic hematopoietic cell transplant: what patients wish they had known about quality of life. Bone Marrow Transplant 2014; 49: 299–303.

    Article  CAS  Google Scholar 

  42. National Institute on AgingOnline Health Information: Can You Trust It? [Internet], 2011 [cited 2015 Feb 17]. Available from http://www.nia.nih.gov/health/publication/online-health-information. Accessed on 17 February 2015.

  43. Posma ER, Weert JC, van Jansen J, Bensing JM . Older cancer patients’ information and support needs surrounding treatment: an evaluation through the eyes of patients, relatives and professionals. BMC Nurs 2009; 8: 1.

    Article  Google Scholar 

  44. Xuereb MC, Dunlop R . The experience of leukaemia and bone marrow transplant: searching for meaning and agency. Psychooncology 2003; 12: 397–409.

    Article  Google Scholar 

  45. Kane HL, Halpern MT, Squiers LB, Treiman KA, McCormack LA . Implementing and evaluating shared decision making in oncology practice. CA Cancer J Clin 2014; 64: 377–388.

    Article  Google Scholar 

  46. Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 2012; 367: 1616–1625.

    Article  CAS  Google Scholar 

  47. Rothberg MB, Sivalingam SK, Ashraf J, Visintainer P, Joelson J, Kleppel R et al. Patients’ and cardiologists’ perceptions of the benefits of percutaneous coronary intervention for stable coronary disease. Ann Intern Med 2010; 153: 307–313.

    Article  Google Scholar 

  48. Discussing Cancer Prognosis | Cancer Network [Internet], 2015 [cited 2015 Mar 26]. Available from http://www.cancernetwork.com/oncology-journal/discussing-cancer-prognosis. Accessed on 25 March 2015.

  49. Levin TT . Discussing cancer prognosis. Oncology (Williston Park) 2015; 29: 142–144, C3.

    Google Scholar 

  50. Gould SJ . The median isn’t the message. Discover 1985. http://www.cancerguide.org/median_not_msg.html. Accessed on 12 March 2014.

  51. Collins AJ, Kasiske B, Herzog C, Chavers B, Foley R, Gilbertson D et al. United States Renal Data System 2006 Annual Data Report Abstract. Am J Kidney Dis 2007; 49: A6–A7.

    Article  Google Scholar 

  52. Murtagh FEM, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE . Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 2007; 22: 1955–1962.

    Article  Google Scholar 

  53. Carson RC, Juszczak M, Davenport A, Burns A . Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 2009; 4: 1611–1619.

    Article  Google Scholar 

  54. Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE . Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 2009; 361: 1539–1547.

    Article  Google Scholar 

  55. Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK . Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation 2007; 83: 1069–1074.

    Article  Google Scholar 

  56. Galla JH . Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. J Am Soc Nephrol 2000; 11: 1340–1342.

    CAS  PubMed  Google Scholar 

  57. Mehrotra R, Marsh D, Vonesh E, Peters V, Nissenson A . Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis. Kidney Int 2005; 68: 378–390.

    Article  Google Scholar 

  58. Heaf J . UNderutilization of peritoneal dialysis. JAMA 2004; 291: 740–742.

    Article  CAS  Google Scholar 

  59. The USRDS Dialysis Morbidity and Mortality Study: Wave 2. US Renal Data System. USRDS 1997 Annual Data Report. National Institutes of Health, USRDS Coordinating Center, Ann Arbor, MI, USA, pp 49–68.

  60. Morton RL, Tong A, Howard K, Snelling P, Webster AC . The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ 2010; 340: c112.

    Article  CAS  Google Scholar 

  61. Bertoli S, Bérard E, Huguet F, Huynh A, Tavitian S, Vergez F et al. Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia. Blood 2013; 121: 2618–2626.

    Article  CAS  Google Scholar 

  62. Elsawy B, Higgins KE . The geriatric assessment. Am Fam Physician 2011; 83: 48–56.

    PubMed  Google Scholar 

  63. Fukuse T, Satoda N, Hijiya K, Fujinaga T . Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest 2005; 127: 886–891.

    Article  Google Scholar 

  64. Aaldriks AA, Maartense E, le Cessie S, Giltay EJ, Verlaan HACM, van der Geest LGM et al. Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011; 79: 205–212.

    Article  CAS  Google Scholar 

  65. Johansson K, Leino-Kilpi H, Salanterä S, Lehtikunnas T, Ahonen P, Elomaa L et al. Need for change in patient education: a Finnish survey from the patient’s perspective. Patient Educ Couns 2003; 51: 239–245.

    Article  Google Scholar 

  66. Rantanen M, Kallio T, Johansson K, Salanterä S, Virtanen H, Leino-Kilpi H . Knowledge expectations of patients on dialysis treatment. Nephrol Nurs J 2008; 35: 249–255 quiz 256.

    PubMed  Google Scholar 

  67. Rankinen S, Salanterä S, Heikkinen K, Johansson K, Kaljonen A, Virtanen H et al. Expectations and received knowledge by surgical patients. Int J Qual Health Care 2007; 19: 113–119.

    Article  Google Scholar 

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Authors and Affiliations

  1. National Marrow Donor Program/Be the Match, Patient and Health Professional Services, Minneapolis, MN, USA

    J Randall

  2. Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey

    K Keven

  3. Department of Geriatric Medicine, Güven Hospital, Ankara, Turkey

    T Atli

  4. Division of Hematology, Department of Medicine, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA

    C Ustun

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Randall, J., Keven, K., Atli, T. et al. Process of allogeneic hematopoietic cell transplantation decision making for older adults. Bone Marrow Transplant 51, 623–628 (2016). https://doi.org/10.1038/bmt.2015.241

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