Use of geriatric assessment in hematopoietic cell transplant

Jayani, Reena; Rosko, Ashley; Olin, Rebecca L.; Artz, Andrew S.

doi:10.1016/j.jgo.2019.09.012

Cited by 31 publications

(15 citation statements)

References 98 publications

(136 reference statements)

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“…The demographic evolution of most industrialized countries calls for an age-sensitive approach and the present coronavirus pandemic crisis makes this extremely important. The clinical relevance of CGA in the oldest adults without cancer is beyond any doubt, has also been recommended in cancer patients by several scientific societies [ 6 , 7 , 8 ], and it is being performed in patients diagnosed with HMs [ 9 , 14 , 15 ]. Nevertheless, gender, smoking habit, nutrition, comorbidity, etc., are not exclusive of the oldest adults and are also relevant for those in their fifties, while their impact is probably limited in younger patients.…”

Section: Discussionmentioning

confidence: 99%

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Ramos

González-Carmona

Porras-Guerra

et al. 2020

JPM

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Several societies have published recommendations for evaluating older adults with cancer in standard conditions. It is vital to assure a proper systematic patient condition evaluation, not only in the oldest (geriatric assessment) but in all adult patients. We have investigated the feasibility of a systematic evaluation of the general condition of all patients diagnosed with hematologic malignancies, and the degree of acceptance by the clinical team, in a prospective cohort of 182 consecutive adults, by using the ECOG performance status scale (ECOG, age 18 and over, 18+), Lee Index for Older Adults (LEE, 50+), Geriatric Assessment in Hematology (GAH, 65+), and the Comprehensive Geriatric Assessment (CGA, 75+). Clinical team acceptance was analyzed with a visual analogue scale, and the objective feasibility was calculated as the proportion of patients that could be finally evaluated with each tool. Acceptance was high, but the objective feasibility was progressively lower as the complexity of the different tools increased (ECOG 100%, LEE 99.4%, GAH 93.2%, and CGA 67.9%). LEE and GAH categories showed a weak concordance (Cohen’s Kappa 0.24) that was slight between LEE and CGA (Kappa 0.18). Unexpectedly, we found no significant association between the GAH and CGA categories (p = 0.16). We confirm that a systematic evaluation of all adult patients diagnosed with hematologic malignancies is feasible in daily practice by using an age-adapted approach. Direct comparisons among the different predictive tools in regard to patients’ tolerance to treatments of different intensities must be a priority research subject in the coming years.

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Section: Discussionmentioning

confidence: 99%

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Ramos

González-Carmona

Porras-Guerra

et al. 2020

JPM

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“…Although observed in fewer studies, there were also associations between geriatric impairments and other adverse outcomes, such as treatment-related toxicity, treatment non-completion, and longer hospital stay. Geriatric assessment has also been investigated in older people submitted to allogeneic HSCT, [68][69][70] showing that geriatric impairments are correlated with increased post-transplant mortality.…”

Section: Geriatric Assessmentmentioning

confidence: 99%

Frailty assessment in the care of older people with haematological malignancies

Goede

Neuendorff

Schulz

et al. 2021

The Lancet Healthy Longevity

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“…To appreciate resiliency, geriatric assessment findings must be contextualized to the proposed HCT plan (e.g., autologous vs. allogeneic, myeloablative vs. reduced-intensity conditioning regimen) to inform resilience. Geriatric assessment frequently uncovers health impairments among patients age 50 or older, 25 even among those with good performance status. 26,27 Limitations in geriatric assessment-rated function and cognition track independently with higher nonrelapse mortality after alloHCT.…”

Section: Practical Applicationsmentioning

confidence: 99%

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

Wildes¹,

Artz

2021

American Society of Clinical Oncology Educational Book

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With the aging of the population, the number of older adults with hematologic malignancies is growing, and treatment paradigms for these patients are rapidly evolving. Use of allogeneic stem cell transplant has been expanding to include septuagenarians but remains a potentially morbid procedure, creating an opportunity for a geriatric-focused evaluation to improve assessment of the individual’s risk in undergoing the procedure. Although age alone should not be the sole determinant for transplant eligibility, geriatric assessment often identifies vulnerabilities that are not captured in assessing performance status and comorbidities alone. Those vulnerabilities may be optimized in an approach employing three sequential steps: characterize resiliency, bolster resilience, and harmonize with patient goals. Data are emerging that show that this approach is associated with lower nonrelapse mortality, shorter length of stay, and better survival after transplant. In older adults with myeloma, treatment recommendations also aim to balance the expected efficacy and toxicity profile and incorporate the patient’s goals and preferences. Assessment of frailty allows for more personalized estimates of risk of toxicity. Currently, the European Myeloma Network currently recommends using the International Myeloma Working Group frailty scale as a standard approach to defining frail or at-risk populations with myeloma. In addition to treatment selection, the care of older adults with myeloma must include consideration of other issues, including reducing early mortality with antibiotic prophylaxis, polypharmacy, depression, cognition, and falls. Overall, appreciation of the aging-associated vulnerabilities will allow for the ultimate personalized care and treatment of older adults with hematologic malignancies.

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Use of geriatric assessment in hematopoietic cell transplant

Cited by 31 publications

References 98 publications

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Patient General Condition at Diagnosis: A Systematic Evaluation for Adults Diagnosed with Hematologic Malignancies

Frailty assessment in the care of older people with haematological malignancies

Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies

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