Ombres Rachel, des Bordes Jude K A, Popat Uday R, Yennu Sriram, Champlin Richard E, Mohile Supriya G, Kebriaei Partow, Holmes Holly M
Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
Department of Family Medicine, McGovern Medical School, Houston, TX, United States of America.
J Geriatr Oncol. 2022 Mar;13(2):194-199. doi: 10.1016/j.jgo.2021.08.008. Epub 2021 Sep 4.
Increasing numbers of older adults undergo allogeneic stem cell transplantation (SCT) as the only chance of meaningful survival for hematologic malignancies. However, toxicities in vulnerable patients may offset the benefits of SCT. Frailty and abnormal geriatric assessment (GA) prior to SCT have been associated with decreased overall survival in persons aged 60 and older. The purpose of this pilot study was to determine the prevalence of baseline GA deficits and frailty, the prevalence of frailty or death at three and six months after allogeneic SCT, and associations between baseline assessments and the presence of frailty or death post-SCT.
We enrolled 50 patients aged 60 years and older and completed a baseline GA including comorbidity, polypharmacy, nutrition, physical performance, functional status, social support, depression and anxiety, and cognition. Frailty was defined as three or more abnormalities of gait speed, grip strength, weight loss, physical activity, and exhaustion, and was assessed at baseline, three months, and six months after SCT. A composite outcome of frailty or death at three months and six months was analyzed.
Frailty was present in 11/50 (22%) of patients at baseline. Ten patients did not complete three- month follow-up, and twelve patients did not complete six-month follow-up. Of those with follow-up data, 22 patients (55%) were frail or deceased three months after SCT, and 27 patients (71%) were frail or deceased six months after SCT. Frailty at baseline was not significantly associated with frailty or death at three or six months after SCT. However, the study's small enrollment limits conclusions on these associations.
GA deficits and frailty are prevalent in older adult SCT recipients at baseline and after transplant. Future studies should aim for larger enrollment in order to validate associations between these deficits and outcomes, especially survival, functional status, and quality of life following SCT.
越来越多的老年人接受异基因干细胞移植（SCT），将其作为血液系统恶性肿瘤患者获得有意义生存的唯一机会。然而，脆弱患者的毒性反应可能会抵消SCT的益处。SCT前的衰弱和异常老年评估（GA）与60岁及以上人群的总生存率降低有关。本初步研究的目的是确定基线GA缺陷和衰弱的患病率、异基因SCT后3个月和6个月时衰弱或死亡的患病率，以及基线评估与SCT后衰弱或死亡存在之间的关联。
我们纳入了50名60岁及以上的患者，并完成了一项基线GA评估，包括合并症、多种药物治疗、营养、身体机能、功能状态、社会支持、抑郁和焦虑以及认知情况。衰弱被定义为步态速度、握力、体重减轻、身体活动和疲惫这三项或更多项异常，并在SCT后的基线、3个月和6个月时进行评估。分析了3个月和6个月时衰弱或死亡的综合结局。
基线时，11/50（22%）的患者存在衰弱。10名患者未完成3个月的随访，12名患者未完成6个月的随访。在有随访数据的患者中，22名患者（55%）在SCT后3个月时衰弱或死亡，27名患者（71%）在SCT后6个月时衰弱或死亡。基线时的衰弱与SCT后3个月或6个月时的衰弱或死亡无显著关联。然而，本研究的小样本量限制了关于这些关联的结论。
GA缺陷和衰弱在老年SCT受者的基线期和移植后普遍存在。未来的研究应以更大的样本量为目标，以验证这些缺陷与结局之间的关联，特别是SCT后的生存率、功能状态和生活质量。
