Division of Hematology, The Ohio State University, Columbus, OH, United States.
Division of Hematology, The Ohio State University, Columbus, OH, United States.
J Geriatr Oncol. 2019 May;10(3):479-485. doi: 10.1016/j.jgo.2018.05.015. Epub 2018 Jul 6.
Multiple myeloma (MM) is a disease of aging adults and autologous stem cell transplant (ASCT) is considered the standard of care. As the population ages a growing number of older adults will undergo ASCT and an objective approach to estimate physiologic reserve and transplant morbidity risk is warranted. Here, we evaluate assess p16 (p16), a molecular aging biomarker, along with geriatric metrics to determine risk of transplant toxicity.
We prospectively evaluated 100 MM patients for frailty before and after ASCT using a Geriatric Assessment (GA) and collected T-cells for analysis of p16 using a custom nanostring codeset.
Pre-transplant physical function was predicative of hospital length of stay (LOS). Each one-unit increase in physical function score, the average LOS decreased by 0.52 days (95% CI, -1.03-0.02); p = .04). Similarly, higher self-report of ADL/IADL (Human Activity Profile was associated with shorter LOS (0.65 less days (95% CI -1.15 to -0.15), p = .01). Patients with anxiety/depression (OR = 1.10 (95% CI 1.00-1.22), p = .056), lower handgrip strength (OR = 0.90 (95% CI 0.82-0.98), p = .02), falls (OR = 1.60 (95% CI 1.07-2.38), p = .02), or weight loss (OR = 5.65 (95% CI 1.17-25.24), p = .03) were more likely to be re-admitted. The estimated EFS at 1-year was 85% (95% CI, 75-91) with median follow-up of 15.7 months. Weight loss was a significant predictor of EFS (HR = 3.13 (95% CI 1.15-8.50), p = .03). Frailty assessment by self-reported fatigue minimally correlated with T-cell p16 expression (r = 0.28; p = .02). Age, Karnofsky Performance Status (KPS), or Hematopoietic cell transplantation-specific Co-Morbidity Index (HCT-CI) did not predict hospital LOS or readmissions.
Our data illustrate that a GA can identify individuals with MM who are at greater risk for morbidity following ASCT.
本研究前瞻性地使用老年综合评估（GA）在自体干细胞移植（ASCT）前后评估 100 例 MM 患者的虚弱情况，并收集 T 细胞，使用定制的纳米串代码集分析 p16。
移植前的身体功能与住院时间（LOS）有关。身体功能评分每增加一个单位，平均 LOS 减少 0.52 天（95%CI，-1.03-0.02）；p=0.04）。同样，更高的自我报告的 ADL/IADL（Human Activity Profile）与更短的 LOS 相关（少 0.65 天（95%CI -1.15 至 -0.15），p=0.01）。焦虑/抑郁（OR=1.10（95%CI 1.00-1.22），p=0.056）、握力较低（OR=0.90（95%CI 0.82-0.98），p=0.02）、跌倒（OR=1.60（95%CI 1.07-2.38），p=0.02）或体重减轻（OR=5.65（95%CI 1.17-25.24），p=0.03）的患者更有可能再次入院。在 1 年时估计的 EFS 为 85%（95%CI，75-91），中位随访时间为 15.7 个月。体重减轻是 EFS 的显著预测因子（HR=3.13（95%CI 1.15-8.50），p=0.03）。自我报告的疲劳对 T 细胞 p16 表达的虚弱评估相关性最小（r=0.28；p=0.02）。年龄、卡诺夫斯基表现状态（KPS）或造血细胞移植特异性合并症指数（HCT-CI）均不能预测住院 LOS 或再入院。
我们的数据表明，GA 可以识别出在 ASCT 后发病率更高的 MM 患者。
