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Multidimensional geriatric assessment for elderly hematological patients (≥60 years) submitted to allogeneic stem cell transplantation. A French–Italian 10-year experience on 228 patients

Bone Marrow Transplantation volume 55, pages 2224–2233 (2020)Cite this article

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Abstract

Nowadays, the evaluation of elderly patients' eligibility for allogeneic stem cell transplantation (allo-SCT) is crucial. We evaluated the feasibility and efficacy of a multidimensional geriatric assessment, the Fondazione Italiana Linfomi (FIL) score, on a cohort of 228 patients older than 60 years submitted to allo-SCT in Italy and France from 2008 to 2018. Based on FIL score, available in 215 patients, 125 (58%) patients were classified as “fit” and 90 as “unfit/frail.” The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was measured in 222 patients (97%); 71 (32%) patients had HCT-CI 0, 75 (34%) patients scored 1–2, and 76 (34%) ≥3. A total of 121 (53%) patients died after a median follow-up of 36 months. FIL score was found to highly predict survival, due to an excess of NRM in unfit/frail group, and confirmed its independent prognostic role on OS (HR: 0.37; 95% CI: 0.25–0.55; p < 0.0001). On the contrary, the HCI-CI failed in allo-SCT outcome prediction (HR: 1.06; 95% CI: 0.96–1.16; p = 0.27). In summary, a comprehensive geriatric assessment with FIL score seems to add significant prognostic information in elderly patients submitted to allo-SCT. The pretransplant adoption of this easy-to-use tool could help the patients’ selection and management.

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Fig. 1: Outcomes after allo-SCT.
Fig. 2: Karnofsky Performance Status distribution among different FIL categories (overall p value < 0.001).
Fig. 3: Outcomes after allo-SCT according to HCT-CI and CIRS-G score.
Fig. 4: Outcomes after allo-SCT according to FIL score.
Fig. 5: Factors associated with OS and NRM.

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  1. These authors contributed equally: Mohamad Mohty, Domenico Russo

Authors and Affiliations

  1. Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy

    Nicola Polverelli, Paolo Tura, Michele Malagola, Simona Bernardi, Lisa Gandolfi, Tatiana Zollner, Camilla Zanaglio, Mirko Farina, Enrico Morello, Alessandro Turra & Domenico Russo

  2. Department of Hematology and Cellular Therapy, “Saint Antoine Hospital” AP-HP, Paris, France

    Paolo Tura, Giorgia Battipaglia & Mohamad Mohty

  3. Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL), ASST Spedali Civili of Brescia, Brescia, Italy

    Simona Bernardi & Camilla Zanaglio

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Polverelli, N., Tura, P., Battipaglia, G. et al. Multidimensional geriatric assessment for elderly hematological patients (≥60 years) submitted to allogeneic stem cell transplantation. A French–Italian 10-year experience on 228 patients. Bone Marrow Transplant 55, 2224–2233 (2020). https://doi.org/10.1038/s41409-020-0934-1

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