Affiliation:
1. Adult Bone Marrow Transplant Service and
2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY;
3. Weill Cornell Medical College, New York, NY; and
4. Geriatrics Service, Memorial Sloan Kettering Cancer Center, New York, NY
Abstract
Abstract
Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; P = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; P = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; P = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.
Publisher
American Society of Hematology
Reference49 articles.
1. Hematopoietic cell transplantation for older adults;Giralt,2017
2. Changes in the survival of older patients with hematologic malignancies in the early 21st century;Pulte;Cancer,2016
3. D’Souza
A
, FrethamC. Current uses and outcomes of hematopoietic cell transplantation (HCT): CIBMTR summary slides, 2017. http://www.cibmtr.org/ReferenceCenter/SlidesReports/SummarySlides/pages/index.aspx. Accessed 15 July 2018.
4. Conditioning regimens for hematopoietic cell transplantation: one size does not fit all;Gyurkocza;Blood,2014