With an increasing number of older patients undergoing allogeneic hematopoietic cell transplantation (HCT), researchers studied the incidence and impact of transplant-related geriatric syndromes. The results suggest that older patients may benefit from geriatric assessment and targeted interventions aimed at improving outcomes prior to and during treatment.
The study included 527 patients 60 years of age or older who underwent a first HCT from 2001-2016. The incidence of delirium was the most common geriatric syndrome at 21% (95% confidence index [CI], 18-25%) at day 100, with falls being the second most common at 7% (95% CI, 5-9%).
Pre-transplant variables impacting delirium during treatment included a fall within the last year, possible inappropriate medication use, thrombocytopenia and reduced creatinine clearance. Factors associated with falls included age older than 70 years and impaired activities of daily living.
At 100 days post-HCT, both delirium (p=0.023) and falls (p=0.026) were associated with increased long-term non-relapse mortality. Falls were associated with reduced overall survival (p=0.016), but not delirium.
With the identification of potentially modifiable risk factors, the researchers recommend that all older patients receive a pre-HCT geriatric assessment in order to develop individualized treatment interventions to improve patient outcomes. Possible interventions include a pharmacist-led medication review and neurocognitive, physical and occupational therapy for patients with or who develop HCT-related geriatric syndromes.
The upcoming Blood and Marrow Transplant Clinical Trials Network trial 1704 (CHARM) will prospectively look at how to improve health assessments and prediction of toxicity and mortality in older patients undergoing HCT.