In a new retrospective study of geriatric patients who underwent allogeneic hematopoietic cell transplantation (alloHCT) for hematologic malignancies, cognitive impairment was found to be associated with nonrelapse mortality (NRM). Results were reported in the journal Blood Advances.1
For this analysis, 330 patients underwent geriatric assessments (GAs) prior to alloHCT, including assessment of instrumental activities of daily living (IADL). Other GAs that were evaluated in some patients included Timed Up and Go (TUG), Blessed Orientation Memory Concentration (BOMC), and Medical Outcomes Study Physical Health (MOS-PH) score.
Median patient age was 63 years (range, 50 to 77). Slightly more than one-third of patients (36%) showed 1 or more impairments in IADLs. Cognitive impairments were seen in 17% of patients based on BOMC scores of 7 or higher, and 14% of patients had TUG times of 13.5 seconds or more. The patient population had a median MOS-PH score of 80.
Nonrelapse mortality and overall survival (OS) were not found to have associations with age or IADLs. However, a multivariate analysis indicated that cognitive impairment had a significant, independent relationship with poorer 1-year OS (hazard ratio [HR], 1.94 [95% CI, 1.14-3.31]; P =.01). Cognitive impairment and having a Hematopoietic Cell Transplant-Comorbidity Index score of 3 or higher each were significant, independent predictors of 1-year NRM, with subdistribution HRs slightly higher than 2 for each.
The researchers noted that the lack of a link between IADL and survival outcomes in this study was in contrast to prior research. “In this first multi-institutional study of GA prior to alloHCT, we demonstrate for the first time an association between pre-alloHCT cognitive impairment, as measured by BOMC ≥7, and inferior OS due to increased NRM,” stated the researchers in their report.
Olin RL, Fretham C, Pasquini MC, et al. Geriatric assessment in older alloHCT recipients: association of functional and cognitive impairment with outcomes. Blood Adv. 2020;4(12):2810-2820.