Prognostic Value of Geriatric Characteristics in Allogeneic Haematopoietic Stem Cell Transplant Recipients Aged Over...

Allogeneic haematopoietic stem cell transplant (alloHSCT) offers a curative option for older adults with haematological malignancies. The use of geriatric assessments has transformed the landscape of haemato-oncology care by improving risk stratification. We aim to study the prognostic value of geriatric characteristics in patients aged ≥ 60 years who underwent alloHSCT at Singapore General Hospital between 2017 and 2023. Patient data were examined retrospectively.

A total of 66 patients were included, with a median age of 65 years and 42% aged above 65. Most patients had acute leukaemia (61%), and stem cell sources included matched sibling donor (18%), matched unrelated donor (33%) and haploidentical donor (48%). Karnofsky Performance Status (KPS) was ≥ 90 in 41% of patients, and 86% had Haematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) scores of 0-2. The median Cumulative Illness Rating Scale-Geriatric (CIRS-G) score was 5. A total of 12% had renal insufficiency.At a median follow-up of 32.5 months, 2-year non-relapse mortality (NRM), progression-free survival and overall survival (OS) were 21%, 55% and 58%, respectively. On multivariate analysis, age > 65 years (HR 3.84, p = 0.027) and renal insufficiency (HR 6.28, p = 0.005) were associated with increased risks of NRM. Similarly, age > 65 years (HR 2.75, p = 0.03) and renal insufficiency (HR 3.46, p = 0.01) conferred inferior OS. KPS, HCT-CI, CIRS-G, albumin, body mass index and polypharmacy did not predict for NRM and OS.

This study supports the feasibility of alloHSCT as a treatment option for older adults with haematological malignancies. Prospective studies incorporating geriatric assessment will allow personalised transplant strategies to improve post-transplant outcomes. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.