San Francisco VA Health Care System, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
San Francisco VA Health Care System, San Francisco, CA, USA; Division of Geriatrics, University of California San Francisco, San Francisco, CA, USA.
J Geriatr Oncol. 2023 Nov;14(8):101623. doi: 10.1016/j.jgo.2023.101623. Epub 2023 Sep 6.
Allogeneic hematopoietic cell transplantation (alloHCT) is increasingly offered to older adults, and its potential impact on cognition in this population is understudied. This work aims to evaluate the ability of cancer-specific geriatric assessments (cGA) and a global frailty index based on accumulation of deficits identified in the cGA to predict the risk of cognitive decline after alloHCT in older adults.
AlloHCT recipients aged 50 years or older completed a cGA, including a cognitive evaluation by the Blessed Orientation Memory Concentration (BOMC) test, at baseline prior to alloHCT and then at 3, 6, and 12 months after transplant. Baseline frailty was assessed using a deficit accumulation frailty index (DAFI) calculated from the cGA. A multinomial logit model was used to examine the association between predictors (individual cGA measures, DAFI) and the following three outcomes: alive with stable or improved cognition, alive with cognitive decline, and deceased. In post-hoc analyses, analysis of variance was used to compare BOMC scores at baseline, 3, 6, and 12 months across frailty categories.
In total, 148 participants were included, with a median age of 62 (range 50-76). At baseline, 12% had cognitive impairment; at one year, 29% of survivors had improved BOMC scores, 33% had stable BOMC, and 37% had worse BOMC. Prior to transplant, 25% were pre-frail and 11% were frail. Individual baseline cGA measures were not associated with cognitive change at one year as assessed by BOMC. Adjusting for age, sex, and education, those who were frail at baseline were 7.4 times as likely to develop cognitive decline at one year than those who were non-frail, although this finding did not reach statistical significance (95% confidence interval [CI] 0.74-73.8, p = 0.09). The probability of being alive with stable/improved cognition at 12 months for the non-frail, pre-frail, and frail groups was 43%, 34%, and 8%, respectively.
Baseline geriatric measures and frailty were not significantly associated with cognitive change as assessed by BOMC in adults aged 50 or older after alloHCT. However, the study was underpowered to detect clinically meaningful differences, and future work to elucidate potential associations between frailty and cognitive outcomes is warranted.
异基因造血细胞移植（alloHCT）越来越多地应用于老年人，但其对该人群认知的潜在影响研究较少。本研究旨在评估癌症特定的老年综合评估（cGA）和基于 cGA 中确定的累积缺陷的整体虚弱指数是否能够预测老年 alloHCT 后认知能力下降的风险。
年龄在 50 岁或以上的 alloHCT 受者在 alloHCT 前基线时完成了 cGA，包括使用Blessed 定向记忆浓度（BOMC）测试进行认知评估，然后在移植后 3、6 和 12 个月进行评估。基线时使用从 cGA 计算的累积缺陷虚弱指数（DAFI）评估虚弱。使用多项逻辑回归模型检查预测因子（个体 cGA 测量值、DAFI）与以下三个结果之间的关联：存活且认知稳定或改善、存活且认知下降和死亡。在事后分析中，使用方差分析比较了虚弱类别之间基线、3、6 和 12 个月的 BOMC 分数。
共纳入 148 名参与者，中位年龄为 62 岁（范围 50-76 岁）。基线时，12%的人有认知障碍；在一年时，33%的幸存者 BOMC 评分稳定，37%的人 BOMC 评分更差。移植前，25%的人处于虚弱前期，11%的人处于虚弱状态。个体基线 cGA 测量值与 BOMC 评估的一年时认知变化无关。在调整年龄、性别和教育程度后，与非虚弱者相比，基线时虚弱者在一年内发生认知下降的可能性高 7.4 倍，尽管这一发现无统计学意义（95%置信区间[CI]0.74-73.8，p=0.09）。非虚弱、虚弱前期和虚弱组在 12 个月时稳定/改善认知的存活概率分别为 43%、34%和 8%。
在 alloHCT 后年龄在 50 岁或以上的成年人中，基线老年综合评估和虚弱程度与 BOMC 评估的认知变化无显著相关性。然而，该研究的效力不足以检测到有临床意义的差异，因此有必要开展进一步的工作以阐明虚弱与认知结局之间的潜在关联。
