Quality of life and outcomes in patients⩾60 years of age after allogeneic hematopoietic cell transplantation

Abstract

Hematopoietic cell transplantation (HCT) has become an established standard of care for many older patients with hematologic malignancies. The effect of transplantation on the quality of life (QOL) of older patients, however, has not been well studied. We thus analyzed QOL in patients ⩾ 60 undergoing an allogeneic HCT compared with patients o 60 years. Prospective psychometric instruments were administered to 351 patients who underwent HCT from 2003 to 2010. Psychometric data were assessed longitudinally by validated questionnaires: Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), Coping Inventory and the Profile of Mood State-Short Form. Patients ⩾ 60 reported better social (P = 0.006) and functional well-being (P = 0.05) with FACT assessment, and had better total scores, (P = 0.043) across all time points. When adjusted for baseline QOL scores as a covariate, social well-being remained significantly better, whereas the other scores became non-significant. With a median follow-up of 49 months, there were no significant differences in OS, relapse-free survival, relapse or chronic GVHD. This study provides further evidence that advanced age should not be a barrier in the decision to pursue allogeneic HCT. Older patients achieved comparable QOL when compared with younger patients.

Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients

“…Many factors predict survival outcomes after allogeneic HCT, including patient age, comorbidities, donor source, performance status, diagnoses, disease status, and carepartner support. Although several studies have investigated and described QOL after transplantation, including the trajectory of QOL risk factors for QOL impairments and interventions to improve QOL, [13][14][15][16][17][18][19][20] the association of pre-transplantation QOL with recovery and survival after allogeneic HCT has not been well described. We hypothesized that QOL measures before HCT may add to the prognostic information provided by known clinical factors among allogeneic HCT recipients.…”

Process of allogeneic hematopoietic cell transplantation decision making for older adults

“…31 A review article by Pidala et al 32 found that older age, advanced disease at transplant, chronic GvHD, lower functional status and less social support were predictors of poorer QOL post-HCT. In contrast, Hamilton et al 33 found that older survivors achieved comparable QOL to younger survivors. Figure 1.…”

Allogeneic Hematopoietic Cell Transplantation for Older Adults with Acute Myeloid Leukemia

“…One study suggests that older patients experience worse physical well-being but better social well-being compared to their younger counterparts [ 70 ]. Other studies are mixed suggesting that older patients may achieve better, comparable, or worse QoL than younger patients [ 71 , 72 , 73 ].…”