Cognitive Impairment Is Associated with Inferior Survival and Increased Non-Relapse Mortality in Older Allogeneic Hematopoietic Cell Transplant (alloHCT) Recipients: A Multicenter Retrospective Study

Introduction: Use of alloHCT is increasing in older patients, but the best means of determining alloHCT candidacy is uncertain. Geriatric assessment (GA), including validated geriatric metrics such as Instrumental Activities of Daily Living (IADL), offers promise to improve prognostication and decision making. We identified a multicenter retrospective cohort of older patients (pts) with pre-alloHCT GA data and examined the impact of GA impairments on post-alloHCT outcomes as reported to the Center for International Blood and Marrow Transplant (CIBMTR) registry. Methods: Pts across 6 participating centers were included in the cohort who met the following inclusion criteria: first alloHCT performed in the U.S. from 2011-2017; age ≥50 years; consented to CIBMTR registry study; and GA incorporating an IADL score collected within 3 months prior to transplant. Additional pre-alloHCT geriatric metrics were collected where available and included: Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and Blessed Orientation Memory Concentration (BOMC). Univariate regression analyses examined the effect of demographic, clinical, and geriatric covariates on overall survival (OS), progression-free survival (PFS) and non-relapse mortality (NRM). Variables significant at p Results: Among 330 pts meeting inclusion criteria, median age was 63 (range 50-77), 60% were male, and 89% were Caucasian. AML and MDS accounted for 79% of transplant indications (46% and 33% respectively). Conditioning was myeloablative in 32%. Karnofsky performance status (KPS) was ≤ 80 in 27%, and 51% of patients had Hematopoietic Cell Transplant Comorbidity Index (HCTCI) ≥3. Median follow up was 24 months (range 3-61). GA metrics available for analysis included IADL in 100% of pts, MOS-PH in 70%, TUG in 83%, and BOMC in 71%. GA impairments, using published cutoffs, were frequent: of evaluable pts, 36% had IADL impairment (score Conclusion: In this multicenter study of patients ≥50 years undergoing alloHCT, pre-alloHCT cognitive impairment was significantly associated with inferior OS due to increased NRM. In contrast to prior single center studies, IADL impairment was not significantly associated with outcomes. GA validation studies, integrating more refined cognitive testing, should be pursued both to determine candidacy for alloHCT and to identify those likely to benefit from strategies to reduce NRM. Download : Download high-res image (151KB) Download : Download full-size image Figure 1 . Disclosures Olin: Daiichi Sankyo: Research Funding; Astellas: Research Funding; Genentech: Consultancy, Research Funding; Pfizer: Research Funding; Jazz Pharmaceuticals: Consultancy, Honoraria; Revolution Medicine: Consultancy; AstraZeneca: Research Funding; Clovis: Research Funding; Ignyta: Research Funding; MedImmune: Research Funding; Mirati Therapeutics: Research Funding; Novartis: Research Funding; Spectrum: Research Funding. Pasquini: Kite Pharmaceuticals: Research Funding; Novartis: Research Funding; BMS: Research Funding; Medigene: Consultancy; Amgen: Consultancy; Pfizer: Consultancy. Bhatt: Agios: Consultancy; Abbvie: Consultancy; Partner therapeutics: Consultancy; Incyte: Consultancy, Research Funding; Tolero Pharmaceuticals: Research Funding; National Marrow Donor Program: Consultancy; CSL Behring: Consultancy; Pfizer: Consultancy. Giralt: Celgene: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; Novartis: Consultancy; Actinium: Consultancy, Research Funding; Miltenyi: Research Funding; Johnson & Johnson: Consultancy, Research Funding; Jazz Pharmaceuticals: Consultancy; Kite: Consultancy; Spectrum Pharmaceuticals: Consultancy. Popat: Jazz: Consultancy; Bayer: Research Funding; Incyte: Research Funding. Weisdorf: Fate Therapeutics: Consultancy; Pharmacyclics: Consultancy; Incyte: Research Funding. Artz: Miltenyi: Research Funding.