Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients

Muffly, Lori; Kocherginsky, Masha; Stock, Wendy; Chu, Quynh; Bishop, Michael; Godley, Lucy A.; Kline, Justin; Liu, Hongtao; Odenike, Olatoyosi; Larson, Richard A.; Besien, Koen van; Artz, Andrew S.

doi:10.3324/haematol.2014.103655

Cited by 225 publications

(179 citation statements)

References 36 publications

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“…13 The ability to perform tasks necessary to live independently in the community, that is, shopping, food preparation, housekeeping, laundry, transportation, handling finances and medication bears most importantly on the survival of older adults. Muffly et al 15 found that the presence of slow walking speed and low mental health before transplant also have prognostic value for poorer survival. Finally, older age and GvHD are principal risk factors for non-relapse death and late death; and even when alloHCT is successful, life expectancy is still lower than expected.…”

Section: Functional Considerationsmentioning

confidence: 99%

“…Although age is a factor, research has shown that co-morbidities and performance status are stronger predictors of survival than age. [13][14][15][16] Wedding et al found that impairment of instrumental activities of daily living was the single most predictive variable of survival in their sample of AML patients ages 19-85 years (median 61.1). 13 The ability to perform tasks necessary to live independently in the community, that is, shopping, food preparation, housekeeping, laundry, transportation, handling finances and medication bears most importantly on the survival of older adults.…”

Section: Functional Considerationsmentioning

confidence: 99%

“…15 The results could also be used to inform patients selecting their treatment option. Geriatric assessment tools are designed to evaluate an older person's functional ability, physical health, cognition, mental health and socioenvironmental circumstances.…”

Section: Older Patients With Other Diseases: Decision Making In Nephrmentioning

confidence: 99%

See 2 more Smart Citations

Process of allogeneic hematopoietic cell transplantation decision making for older adults

Randall

Keven

Atlı

et al. 2015

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (alloHCT) may be the only curative option for some older adults with hematologic malignancies, and its associated risks of significant morbidity and mortality warrant a clear, informed decision-making process. As older adults have not been transplanted routinely until recent years, younger people have been the prototypical group around whom the current process has developed. Yet, this process is applied to older adults who have different considerations than younger patients when making their transplant decision. Older adults do not have the open-ended lives of younger patients and are entitled to consider how to spend their remaining time. They also possess maturity and experience, and with proper knowledge, they can make informed choices rather than moving forward in the transplant process unaware. Notably, older patients face similar problems with the informed decision-making process in nephrology. Strategies such as providing education about alloHCT gradually and repeatedly during induction, presenting recent knowledge from the literature in plain language, and utilizing a team approach to patient education may help older adults make the best decision about transplant in light of their situation and values. Understanding when and how older adults decide on alloHCT is an important first step to further exploring this problem.

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Section: Functional Considerationsmentioning

confidence: 99%

Section: Functional Considerationsmentioning

confidence: 99%

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Process of allogeneic hematopoietic cell transplantation decision making for older adults

Randall

Keven

Atlı

et al. 2015

Bone Marrow Transplant

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“…Emerging evidence suggests that risk factors predictive of induction outcomes are also predictive of outcomes after BM transplantation, 44 further highlighting the need for systematic approaches to patient assessment in trials and practice. Ultimately, understanding specific patient vulnerabilities will help to: (1) predict treatment tolerance and benefit for available therapies, (2) inform novel clinical trial design to target specific patient subgroups and explore the relationship between tumor and patient biology, and (3) identify targets for intervention to improve supportive care during therapy (ie, exercise for physical impairment 45 ).…”

Section: Next Steps To Move Research To Practicementioning

confidence: 99%

Geriatric perspective: how to assess fitness for chemotherapy in acute myeloid leukemia

Klepin

2014

Hematology

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Characterizing "fitness" in the context of therapeutic decisions for older adults with acute myeloid leukemia (AML) is challenging. Available evidence is strongest in identifying those older adults who are frail at the time of diagnosis by characterizing performance status and comorbidity burden. However, many older adults with adequate performance status and absence of major comorbidity are "vulnerable" and may experience clinical and functional decline when stressed with intensive therapies. More refined assessments are needed to differentiate between fit and vulnerable older adults regardless of chronologic age. Geriatric assessment has been shown to add information to routine oncology assessment and improve risk stratification for older adults with AML. This review highlights available evidence for assessment of "fitness" among older adults diagnosed with AML and discusses future treatment and research implications. Learning Objective• To recognize patient characteristics that influence treatment tolerance for older adults receiving chemotherapy for AMLThe majority of patients with acute myeloid leukemia (AML) are age 65 or older, with approximately one-third of patients Ն75 years of age at diagnosis. 1 Despite this, the optimal treatment for older patients remains unclear. Compared with middle-aged patients, older adults (typically defined as Ն60 or 65 years) experience shortened survival and increased treatment-associated morbidity. [1][2][3] For example, population-based data from the United States (Surveillance Epidemiology End Results, SEER) highlight the age-related survival disparity. Rates of 5-year survival from time of diagnosis decline from 39% to 8.5% to Ͻ2% for people Ͻ65, 65-74, and Ն75 years of age, respectively. 1 Older adults are more likely to experience treatment-related death than younger patients, ranging from 10% to 30% in many clinical trials. [2][3][4] Chronologic age, however, is a surrogate measure for both changes in tumor biology (conferring treatment resistance) and patient characteristics (affecting treatment tolerance). Both tumor biology and physiologic reserve vary widely among older adults of similar chronologic age, necessitating individualized assessment strategies. Controversy of intensive therapy for older adults with AMLConcerns regarding efficacy and toxicity of standard treatments have resulted in Ͻ40% of older adults receiving chemotherapy for AML in the United States. 5 Despite poor outcomes for older adults in aggregate, clinical trial and observational data show that chemotherapy can improve survival for selected patients, even those Ͼ80 years of age. 4-7 A landmark study comparing intensive induction in a randomized fashion to supportive care demonstrated a small but measurable survival advantage for patients 65 years of age and older. 4 Survival has improved over time in both observational data and clinical trials, although the magnitude of improvement declines with increased age. 1,5,[8][9][10][11] Observational data also suggest that the effect of induction th...

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“…However, we know that comorbidity, functional status and standard geriatric measures will stratify outcomes for older transplant patients. 10,11 Likewise, psychosocial health not only plays an important role as a prognostic factor, but psychosocial changes after transplant also influence post-transplant quality of life. Prospective studies are needed though, as morbidity and mortality classified as transplant-related may also be a consequence of pre-existing health conditions, especially for older adults being followed for 2-5 years after HCT.…”

mentioning

confidence: 99%

Hematopoietic cell transplantation in older adults: deciding or decision-making?

Artz

Chow

2016

Bone Marrow Transplant

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Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients

Cited by 225 publications

References 36 publications

Process of allogeneic hematopoietic cell transplantation decision making for older adults

Process of allogeneic hematopoietic cell transplantation decision making for older adults

Geriatric perspective: how to assess fitness for chemotherapy in acute myeloid leukemia

Hematopoietic cell transplantation in older adults: deciding or decision-making?

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