Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older...

Area of Science:

• Hematology
• Geriatric Medicine
• Oncology

Background:

• Geriatric assessment (GA) has limitations for predicting outcomes in older adults undergoing hematopoietic cell transplantation (HCT).
• Worse outcomes are observed in geriatric patients post-HCT when relying solely on traditional GA.
• There is a need for specialized approaches to optimize HCT candidacy in elderly populations.

Purpose of the Study:

• To evaluate the feasibility and impact of a multidisciplinary team clinic (MDC) for older HCT candidates.
• To assess if an MDC improves outcomes compared to traditional GA alone.
• To optimize individualized treatment plans for elderly allogeneic and autologous HCT candidates.

Main Methods:

• Established an MDC integrating cancer-specific GA with a multidisciplinary team.
• Assessed allogeneic HCT candidates aged ≥60 and autologous HCT/adoptive T-cell therapy candidates aged ≥70.
• Compared outcomes of MDC-evaluated patients with historical controls receiving GA alone.

Main Results:

• The MDC evaluated 247 patients, predominantly allogeneic HCT candidates (60%).
• MDC patients had fewer GA-graded functional impairments and comparable high-risk disease profiles to controls.
• MDC cohort showed reduced inpatient deaths, shorter hospital stays, and fewer nursing facility discharges.
• 1-year overall survival improved from 43% to 70%, and nonrelapse mortality decreased from 43% to 18% in the MDC era.
• Autologous HCT recipients (≥70 years) optimized by MDC had 0% nonrelapse mortality and 97% overall survival at 1 year.

Conclusions:

• A GA-guided MDC is a feasible and effective model for older HCT candidates.
• The MDC approach appears to reduce transplant-associated morbidity and mortality.
• Implementing an MDC can facilitate broader and safer utilization of HCT in the elderly population.