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Comprehensive Geriatric Assessment Identifies Significant Functional Impairments in Older Hematopoietic Cell Transplant Recipients

Track: BMT Tandem "Scientific" Meeting
Saturday, March 1, 2014, 4:45 PM-6:45 PM
Texas C (Gaylord Texan)
Rebecca L. Olin, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Charalambos Andreadis, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Thomas G Martin, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jeffrey L Wolf, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lawrence D Kaplan, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Weiyun Ai, MD, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jeffrey M Venstrom, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Aaron C Logan, MD, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Catherine C Smith, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Karin ML Gaensler, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jimmy Hwang, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lloyd E Damon, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Audio File Recorded Presentation

Background: Selection of older patients who are appropriate candidates for Hematopoietic Cell Transplant (HCT) has historically been a largely subjective process. Comprehensive geriatric assessment (CGA) is used to predict treatment toxicities in older patients with solid tumors and hematologic malignancies. We applied a well-validated cancer-specific CGA in the HCT setting to determine whether pre-HCT CGA exposes additional vulnerabilities not quantified by Karnofsky performance status (KPS) and the HCT Comorbidity Index (HCTCI).

Methods: We designed a prospective cohort study enrolling patients ≥50 years undergoing HCT (allogeneic or autologous) at our institution. CGA was performed prior to transplant, and clinical/demographic data were recorded prospectively.

Results: Ninety patients with a median age of 61 (range 50-73) completed a baseline CGA and underwent HCT. (see Table) Patient-assessed KPS was significantly lower than provider-assessed KPS (mean 82 ±15 vs 88 ± 14 respectively, p=0.0002), with only moderate correlation (r=0.53). Thirty-eight patients (42%) had a deficiency in one or more Instrumental Activities of Daily Living (IADL). The mean IADL score was 12.9 ± 2.0 (range 4-14, possible range 0-14). The mean score on the Medical Outcomes Study Physical Health Scale, a measure of Activities of Daily Living (ADL), was 66 ± 26 (range 0-100, possible range 0-100). Mental Health Inventory-5 scores indicating clinical anxiety or depression were reported by 32 patients (36%), although only 10 (11%) met criteria for psychiatric disturbance by HCTCI criteria. There were no significant differences between patients undergoing autologous versus allogeneic HCT in any of the individual CGA measures. In a subset analysis of 64 patients with provider-assessed KPS ≥90, 21 (33%) were dependent in one or more IADL, and 14 (22%) had ADL scores ≤50, the lowest quartile of the group as a whole. Similarly, in the subset of 35 patients with HCTCI scores 0-2, 13 (37%) were dependent in one or more IADL and 10 (29%) had ADL scores ≤50.

Total n=90

Autologous n=51

Allogeneic n=39

Age, median (range)

61 (50-73)

61 (50-73)

61 (50-73)

Female

29 (32%)

11 (22%)

18 (46%)

Diagnoses

Myeloma 39 (76%)

Lymphoma 9 (18%)

Other 3 (6%)

AML 19 (49%)

MDS 12 (31%)

Other 8 (20%)

Myeloablative conditioning

12 (31%)

Provider KPS, mean

88 ± 14

87 ± 13

89 ± 15

HCTCI

 

0

1-2

≥3

17 (19%)

18 (20%)

55 (61%)

13 (25%)

8 (16%)

30 (59%)

4 (10%)

10 (26%)

25 (64%)

Conclusions:  CGA revealed a number of functional impairments in a population of older patients deemed “fit” for HCT. In subsets of patients with provider-assessed KPS ≥90 or HCTCI 0-2, one quarter to one third had quantifiable limitations in ADL/IADL. As this study continues to accrue, we will investigate the association between CGA measures and post-HCT outcomes, including serial CGA post-HCT, and whether such associations are independent of traditional prognostic factors.

Disclosures:
Nothing To Disclose
See more of: Oral Abstracts - Session J - Late Effects/Quality of Life & Supportive Care
See more of: BMT Tandem "Scientific" Meeting
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