474 - High Calculated Glomerular Filtration Rate is Associated with Treatment-Related Mortality in Older Adults Undergoing Allogeneic Hematopoietic Cell Transplantation

Abstract

Background: Older adults are undergoing allogeneic hematopoietic cell transplant (allo-HCT) at historically unprecedented rates. However, identifying older adults at high risk for adverse outcomes remains a challenge. Hypothesis: High calculated glomerular filtration rate (GFR) at the time of transplant admission (TxA) is a surrogate marker for low muscle mass and predicts treatment-related mortality (TRM). Methods: All patients age 65 who underwent allo-HCT at Washington University School of Medicine between October 2012 and June 2017 were retrospectively screened for inclusion. Patients with previous allo-HCT, HLA mismatched unrelated donors and donor-specific antibodies were excluded. GFR was calculated using the Modified of Diet in Renal Disease formula. Patients were stratified into four groups: Low (GFR < 60), Intermediate (60-90), High (90-120) and Very High (>120). The primary outcome was the cumulative incidence of TRM, which was defined as any death prior to day +28 and any death following day +28 without relapse. Relapse was treated as a competing risk. The secondary outcome was overall survival (OS). Results: 127 patients were identified. Median follow up was 6.4 and 15.2 months in all patients and surviving patients, respectively. 23, 68, 29 and 7 patients were in the Low, Intermediate, High and Very High GFR groups at TxA. GFR group was not associated with any baseline demographic or clinical characteristic with the exception of KarnofksyPerformance Score (KPS) (P = .02) (Table 1). TRM at 2 years was significantly different between Low (38%, 95% C.I. 16%-59%), Intermediate (31%, 95% C.I. 19%-43%), High (48%, 95% C.I. 27%-70%) and Very High (71%, 95% C.I. 28%-100%) GFR groups (P = .02) (Figure 1). Similarly, OS was significantly different among the groups (P = .02). On pairwise analysis, Very High GFR was associated with inferior survival compared to all other groups (all P < .01). High GFR was associated with inferior survival compared to Intermediate GFR (P = .046). After adjusting for KPS, Very High GFR continued to be associated with inferior OS (aHR: 4.58, 95% C.I. 1.9-10.9) compared to Intermediate GFR.Table 1Demographics and Clinical Characteristics.GFR CategoryLowIntermediateHighVery HighTotal2368297Age*68 (65-75)68 (65-75)68 (65-76)67 (65-73)Male Gender13 (57)43 (63)20 (69)3 (43)Caucasian22 (96)64 (94)28 (97)7 (100)HCT CI 02 (9)9 (13)3 (10)0 (0) 1 to 25 (22)12 (18)6 (21)3 (43) ≥316 (70)47 (69)20 (69)4 (57)KPS < 9011 (48)31 (46)21 (72)6 (86)*Median (range). Open table in a new tab *Median (range). Conclusion: High GFR was associated with inferior outcomes following allo-HCT. Consequently, GFR at TxA may provide novel information to identify older adults at high risk for TRM during allo-HCT. Larger studies are needed to evaluate this association and prospective studies are needed to evaluate possible interventions to decrease TRM in at-risk patients.