A geriatric assessment-guided multidisciplinary team clinic (MDC) approach for older hematopoietic cell transplantation (HCT) candidates appears to be feasible and may help reduce transplant-associated morbidity and mortality, according to a study published in Blood Advances. Researchers found that a greater adoption of this approach could lead to more widespread utilization of transplantation among older adults.
The team reported outcomes with an MDC approach that included a cancer-specific geriatric assessment and a team of providers who assessed candidacy of patients for HCT. The providers created an individualized optimization plan for allogeneic HCT candidates aged 60 years and older and for autologous HCT and adoptive T-cell therapy candidates aged 70 years and older.
The researchers treated 247 patients with this MDC model, with allogeneic HCT candidates comprising the majority of the cohort (60%), followed by autologous HCT candidates (37%) and older cellular therapy candidates (3%). Patients treated using the MDC approach experienced fewer inpatient deaths (P <.001), shorter length of stay (P <.001), and fewer discharges to nursing facilities (P =.0043) compared with patients treated prior to the implementation of this approach.
The 1-year rate of overall survival improved from 43% prior to implementation of the MDC approach to 70% with the MDC approach, and the 1-year nonrelapse mortality rate decreased from 43% to 18%. For 31 recipients of autologous HCT aged 70 years or older for whom treatment was optimized by the MDC approach, nonrelapse mortality and OS at 1 year were 0% and 97%, respectively.
The researchers noted that until recently, identifying risk factors for expected HCT complications aside from age had been difficult. The MDC approach outlined may offer a way “to maximize resiliency to avoid biases of older age alone and more safely offer hematopoietic and cellular therapies.”
However, the researchers cautioned that their findings have significant limitations because they come from a single institutional observational study of heterogeneous patients and transplant types. Thus, prospective studies are warranted that can more completely characterize the interventions and surrogate markers that may be of most benefit in this patient population.
Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
- Derman BA, Kordas K, Ridgeway J, et al. Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults [published online November 14, 2019]. Blood Adv. doi:10.1182/bloodadvances.2019000790