The use of comprehensive geriatric assessment in older patients before allologeneic hematopoietic stem cell transplantation: A cross-sectional study

Abstract

Objectives: To evaluate the results of the comprehensive geriatric assessment (CGA) before allogeneic hematopoietic stem cell (HSCT) transplantation in patients aged 60 years and over. Methods: We evaluated all consecutive patients undergoing CGA before HSCT between September 2011 and July 2018 in a private hospital in Brazil. We also evaluated the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-SCI) and the Disease Risk Index (DRI). Results: During the study period, 61 patients were referred for transplant evaluation. After exclusions, we analyzed 40 patients, with a mean age of 67.6 years (60-76). The CGA detected vulnerability and frailty in 43% and 18.9% respectively according to the Fried Frailty Phenotype score; limitations across the domain of function and disability with handgrip test alterations in 65.8%. However, 36 (90%) were independent for instrumental activities of daily living (IADL). Cognitive and depression domain have shown abnormal with the clock test in 44.4%, and loss of memory complains in 37.5%. But the mini-mental test was normal in 89%. Geriatric Depression Scale (GDS) was normal in 82.5%. 30% were considered at risk for malnutrition. Half of the patients (50%) had a high Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score. 32.5% needed ICU admission. The overall survival and non-relapse mortality at 2 years were 41.8% and 38.7% respectively. Conclusion: The CGA was feasible in detecting the patients' vulnerabilities in our population. More studies, multicentric and with a larger number of patients, are needed to evaluate the role of CGA in this context of allo-HCT in our population.

Geriatric assessment in older patients with a hematologic malignancy: a systematic review

“…Eight studies focused on acute myeloid leukemia and/or myelodysplastic syndromes, [19][20][21][22][23][24][25]27 two on chronic lymphocytic leukemia, 28,29 13 on lymphoma, [30][31][32][33][34][35][36][37][38][39][40][41][42] seven on multiple myeloma, [42][43][44][45][46][47][48] and 15 studies included various hematologic malignancies. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The median number of domains addressed in the geriatric assessment was four (range, 2-9). These included ADL in 30 studies (68%), IADL in 37 (84%), cognition in 29 (66%), mood in 24 (55%) and objectively measured physical capacity in 20 studies (46%).…”

“…median age less than 68 years old, or more than one third of the patients younger than 65 years old); 22,27,41,43,46,48,50,58,59 these studies were assessed as not being fully representative of the target cohort of the average older patients with a hematologic malignancy. Similarly, eight studies focused on a very specific treatment 20,23,24,31,51,55,56,60 which we considered as not fully representative of our target population. Overall, the duration of follow-up was sufficient but in nine studies the followup rate was less than 90% 24,30,46 or the adequacy of followup was not reported.…”

Delivering intensive therapies to older adults with hematologic malignancies: strategies to personalize care

“…In an effort to capture more of the heterogeneity of the older patient population, to better prognosticate beyond performance status and comorbidities, CGA has been studied in the allogeneic transplant setting. [34][35][36][37][38][39] Although the details of the CGAs in these studies have differed in terms of specific instruments used to measure geriatric domains, some common themes are beginning to emerge. All studies have shown a significant degree of impairment in functional status and other geriatric domains in older patients determined fit for alloHCT, even in patients with excellent performance status and few comorbidities.…”

The Efficacy of the Comprehensive Assessment and Multi-Disciplinary Management of Geriatric and Frail Patients: The Study Protocol of a Multi-Center, Randomized, Parallel Controlled Trial (MDT-F)

“…A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting patients' vulnerabilities [23], identifying elderly patients at high risk for mortality and poor recovery after surgery [23], and predicting outcomes independent of performance status among elderly patients [25]. Multidisciplinary intervention according to the CGA ndings has been shown to improve the activity, anxiety and depression status, fall events, readmission rate and quality of life score to a certain extent [26][27][28].…”