Adult Bone Marrow Transplant Service and.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Blood Adv. 2019 Jan 8;3(1):12-20. doi: 10.1182/bloodadvances.2018028241.
Multifactorial geriatric syndromes are highly prevalent in older patients with cancer. Because an increasing number of older patients undergo allogeneic hematopoietic stem cell transplantation (allo-HCT), we examined the incidence and impact of transplant-related geriatric syndromes using our institutional database and electronic medical records. We identified 527 patients age 60 years or older who had undergone first allo-HCT from 2001 to 2016 for hematologic malignancies. From the initiation of conditioning to 100 days posttransplant, new geriatric syndromes were predominantly delirium with a cumulative incidence of 21% (95% confidence interval [CI], 18%-25%) at day 100 followed by fall at 7% (95% CI, 5%-9%). In multivariable analyses of available pretransplant variables, fall within the last year, potentially inappropriate use of medication, thrombocytopenia, and reduced creatinine clearance were significantly associated with delirium; age older than 70 years and impaired activities of daily living were significantly associated with fall. In the 100-day landmark analysis, both delirium (hazard ratio [HR], 1.66; 95% CI, 1.09-2.52; = .023) and fall (HR, 2.14; 95% CI, 1.16-3.95; = .026) were significantly associated with increased nonrelapse mortality; moreover, fall (HR, 1.93; 95% CI, 1.18-3.14; = .016), but not delirium, was significantly associated with reduced overall survival. Here, we establish baseline incidences and risk factors of common transplant-related geriatric syndromes. Importantly, we demonstrate significant associations of delirium and fall with inferior transplant outcomes. The burden and impact of transplant-related geriatric syndromes warrant the institution of patient-centered, preemptive, longitudinal, and multidisciplinary interventions to improve outcomes for older allo-HCT patients.
多因素老年综合征在老年癌症患者中非常普遍。由于越来越多的老年患者接受同种异体造血干细胞移植（allo-HCT），我们使用我们的机构数据库和电子病历检查了与移植相关的老年综合征的发病率和影响。我们确定了 527 名年龄在 60 岁或以上的患者，他们在 2001 年至 2016 年间因血液系统恶性肿瘤接受了第一次 allo-HCT。从预处理开始到移植后 100 天，新的老年综合征主要是谵妄，其累积发病率为 21%（95%置信区间 [CI]，18%-25%），第 100 天发生跌倒的比例为 7%（95% CI，5%-9%）。在可用于移植前变量的多变量分析中，一年内跌倒、潜在不适当用药、血小板减少症和肌酐清除率降低与谵妄显著相关；年龄大于 70 岁和日常生活活动受损与跌倒显著相关。在 100 天的标志分析中，谵妄（危险比 [HR]，1.66；95%置信区间 [CI]，1.09-2.52； =.023）和跌倒（HR，2.14；95%置信区间 [CI]，1.16-3.95； =.026）均与非复发死亡率增加显著相关；此外，跌倒（HR，1.93；95%置信区间 [CI]，1.18-3.14； =.016）而不是谵妄与总体生存率降低显著相关。在这里，我们确定了常见与移植相关的老年综合征的基线发病率和危险因素。重要的是，我们证明了谵妄和跌倒与较差的移植结果显著相关。移植相关老年综合征的负担和影响需要实施以患者为中心、预防、纵向和多学科的干预措施，以改善老年 allo-HCT 患者的结局。
