Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: A prospective risk factor and serial assessment analysis article

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.