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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Deschler B, Lübbert M. Acute myeloid leukemia: epidemiology and etiology. Cancer. 2006;107:2099–107.
Rombouts WJ, Blokland I, Lowenberg B, Ploemacher RE. Biological characteristics and prognosis of adult acute myeloid leukemia with internal tandem duplications in the Flt3 gene. Leukemia. 2000;14:675–83.
Deschler B, de Witte T, Mertelsmann R, Lubbert M. Treatment decision-making for older patients with high-risk myelodysplastic syndrome or acute myeloid leukemia: problems and approaches. Haematologica. 2006;91:1513–22.
Deeg HJ, Shulman HM, Anderson JE, Bryant EM, Gooley TA, Slattery JT, et al. Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age. Blood. 2000;95:1188–94.
Spyridonidis A, Bertz H, Ihorst G, Grullich C, Finke J. Hematopoietic cell transplantation from unrelated donors as an effective therapy for older patients (>or =60 years) with active myeloid malignancies. Blood. 2005;105:4147–8.
Marks RPK, Hahn J, Ihorst G, Bertz H, Sypridonidis A, Holler E, et al. Reduced-intensity conditioning with fludarabine, BCNU and melphalan in allogeneic hematopoietic cell transplantation: particular activity against adcanced hematological malignancies Blood. 2007
Finke J, Schmoor C, Bertz H, Marks R, Wasch R, Zeiser R, et al. Long-term follow-up of therapy-related myelodysplasia and AML patients treated with allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2016;51:771–7.
Bertz HLM, Ohneberg K, Zeiser R, Wäsch R, Marks R, Finke J. Allogeneic hematopoietic cell transplantation with double alkylating agents containing reduced-intensity conditioning for patients >60 years with advanced AML/MDS. Leukemia 2016;30:2426–9.
Pohlen MGC, Sauer T, Görlich D, Mesters R, Schliermann C, Lenz G, Müller-Tidow C, Büchner T, Berdel WE, Stelljes M. Outcome of allogeneic stem cell tranplantation for AML and myelodysplastic syndrome in elderly patients (>/=60 years). Bone Marrow Transplant. 2016;51:1441–8.
Heidenreich S, Ziagkos D, de Wreede LC, van Biezen A, Finke J, Platzbecker U, et al. Allogeneic stem cell transplantation for patients with myelodysplastic syndrome 70 years of age or older: a retrospective study of the MDS subcommittee of the Chronic Malignancies Working Party (CMWP) of the EBMT. Biol Blood Marrow Transplant. 2017;23:44–52. (e-pub ahead of print 23 January 2016; 10.1016/j.bbmt.2016.09.027).
Muffly LPM, Martens M, Brazauskas R, Zhu X, Adekola K, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients age 70 years and older in the United States. Blood. 2017; https://doi.org/10.1182/blood-2017-03-772368.
Gratwohl A. The EBMT risk score. Bone Marrow Transplant. 2012;47:749–56.
Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25:1824–31.
Deschler B, Ihorst G, Kuhn M, Rüter B, Lübbert M. Geriatric assessment: a prospective study in older patients with AML and high-risk MDS. Crit Rev Oncol/Hematol. 2006;60.
Deschler B, Ihorst G, Rüter B. Lübbert. Multidimensional geriatric assessment in elderly patients with MDS/AML. Crit Rev Oncol Hematol. 2007;64:38.
Deschler B, Binek K, Ihorst G, Marks R, Wasch R, Bertz H, et al. Prognostic factor and quality of life analysis in 160 patients aged >or = 60 years with hematologic neoplasias treated with allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2010;16:967–75.
Deschler B, Ihorst G, Platzbecker U, Germing U, Marz 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;98:208–16. Epub 2012/08/10.
Nordin K, Steel J, Hoffman K, Glimelius B. Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients. Br J Cancer. 2001;85:1265–72.
Efficace F, Bottomley A, Coens C, Van Steen K, Conroy T, Schoffski P, et al. Does a patient’s self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer? Eur J Cancer. 2006;42:42–9.
Karnofsky DA, A W, Craver LF, Burchenal JH. The use of nitrogen mustard in the palliative treatment of carcinoma. Part Ref Bronc-Carcinoma Cancer. 1948;1:634–56.
Artz AS, Pollyea DA, Kocherginsky M, Stock W, Rich E, Odenike O, et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2006;12:954–64.
Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. 1993;1:165–78.
Cockrell JR, Folstein MF. Mini-mental state examination (MMSE). Psychopharmacol Bull. 1988;24:689–92.
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.
Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–5.
Lubke N, Meinck M, Von Renteln-Kruse W. [The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual]. Z Gerontol Geriatr. 2004;37:316–26. Der Barthel-Index in der Geriatrie. Eine Kontextanalyse zum Hamburger Einstufungsmanual.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.
Sorror ML, Maris MB, Sandmaier BM, Storer BE, Stuart MJ, Hegenbart U, et al. Hematopoietic cell transplantation after nonmyeloablative conditioning for advanced chronic lymphocytic leukemia. J Clin Oncol. 2005;23:3819–29.
Charlson MAPP, Ales K, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.
Giles FJ, Borthakur G, Ravandi F, Faderl S, Verstovsek S, Thomas D, et al. The haematopoietic cell transplantation comorbidity index score is predictive of early death and survival in patients over 60 years of age receiving induction therapy for acute myeloid leukemia. Br J Haematol. 2007;136:624–7.
Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG, et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007;25:4246–54.
Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, et al. Overview of the MNA--Its history and challenges. J Nutr Health Aging. 2006;10:456–63. discussion63-5.
Marks R, Potthoff K, Hahn J, Ihorst G, Bertz H, Spyridonidis A, et al. Reduced-toxicity conditioning with fludarabine, BCNU, and melphalan in allogeneic hematopoietic cell transplantation: particular activity against advanced hematologic malignancies. Blood. 2008;112:415–25.
Schumacher MHN, Schwarzer G, Sauerbrei W. Prognostic factor studies in: handbook of statistics in clinical oncology. 2nd edn. In: NY MD editors. Chapman and Hall; 2006.
Fine JP, G R. Proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.
Marubini EVM. Analysing survival data from clinical trails and observational studies. Chichester, England: Wiley; 1995.
Randall JKK, Atli T, Ustuny C. Process of allogeneic hematopoietic cell transplantation decision making for older adults. Bone Marrow Transplant. 2016;51:623–8.
Terret C, Zulian GB, Naiem A, Albrand G. Multidisciplinary approach to the geriatric oncology patient. J Clin Oncol. 2007;25:1876–81.
Walston JHE, Ferrucci L, Guralnik JM, Newman AB, Studenski SA, Ershler WB, Harris T, Fried LP. Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006;54:991–1001.
Rashidi AEM, Colditz GA, DiPersio JF. Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia: a systematic review and meta-analysis. Biol Blood Marrow Transplant. 2016;22:651–7.
McClune BLWD, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J, Dipersio J, Keating A, Gale RP, George B, Gupta V, Hahn T, Isola L, Jagasia M, Lazarus H, Marks D, Maziarz R, Waller EK, Bredeson C, Giralt S. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 2010;28:1878–87.
Muffly LSKM, Stock W, Chu Q, Bishop MR, Godley LA, et al. Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients. Haematologica. 2014;99:1373–9.
Fiuza-Luces CSR, Ramírez M, Lucia A, Berger NA. Physical function and quality of life in patients with chronic GvHD: a summary of preclinical and clinical studies and a call for exercise intervention trials in patients. Bone Marrow Transplant. 2016;51:13–26.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interests.
Electronic supplementary material
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41409-017-0021-4
This article is cited by
-
Transplantation and Cellular Therapy for Older Adults—The MSK Approach
Current Hematologic Malignancy Reports (2024)
-
HCT frailty scale for younger and older adults undergoing allogeneic hematopoietic cell transplantation
Bone Marrow Transplantation (2023)
-
Impact of hematopoietic cell transplant frailty scale on transplant outcome in adults
Bone Marrow Transplantation (2023)
-
Pitfalls and Successes in Trials in Older Transplant Patients with Hematologic Malignancies
Current Oncology Reports (2022)
-
Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation
Bone Marrow Transplantation (2021)