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End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center

Bone Marrow Transplantation volume 54, pages 700–706 (2019)Cite this article

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Abstract

Older patients with acute myelogenous leukemia (AML) are at increased risk for mortality and morbidity. While allogeneic stem cell transplantation may provide cure in some patients, many still relapse after transplant and are then left with limited therapeutic options and poor survival. Moreover, the quality of the end-of-life care for these patients has not been previously reported. We describe here the end-of-life experience of a cohort of 72 older patients with AML who relapsed after first allogeneic stem cell transplant at our dedicated cancer center. Despite a median overall survival of only 4 months, we find a high level of primary palliative care delivered by transplant/leukemia physicians through goals of care discussions and/or advanced care planning and provide evidence for high-quality end-of-life care outcomes, often with concurrent disease-directed therapy. Our results compare favorably with end-of-life care outcomes reported for older AML patients, including those who did not undergo transplant. Given the poor prognosis and unique underlying vulnerabilities in this high-risk patient population, incorporating timely advanced care planning and palliative care delivery while exploring available salvage options may further improve end-of-life care outcomes.

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Acknowledgements

This research was supported in part by the National Institutes of Health award number P01 CA23766 and NIH/NCI Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. RJL also received support from the New York State Empire Clinical Research Investigator Program (ECRIP).

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Authors and Affiliations

  1. Adult BMT Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard J. Lin, Theresa A. Elko, Miguel-Angel Perales, Ann A. Jakubowski, Parastoo B. Dahi, Esperanza B. Papadopoulos & Sergio A. Giralt

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Miguel-Angel Perales, Koshy Alexander, Ann A. Jakubowski, Parastoo B. Dahi, Esperanza B. Papadopoulos, Virginia M. Klimek, Sergio A. Giralt & Judith E. Nelson

  3. Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Koshy Alexander

  4. Epidemiology-Biostatistics, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sean M. Devlin

  5. Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Virginia M. Klimek

  6. Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Judith E. Nelson

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  1. Richard J. Lin
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Correspondence to Richard J. Lin.

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Lin, R.J., Elko, T.A., Perales, MA. et al. End-of-life care for older AML patients relapsing after allogeneic stem cell transplant at a dedicated cancer center. Bone Marrow Transplant 54, 700–706 (2019). https://doi.org/10.1038/s41409-018-0311-5

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  • DOI: https://doi.org/10.1038/s41409-018-0311-5

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