Feasibility and Clinical Utility of Electronic Geriatric Assessment (eGA) in Older Patients Undergoing Hematopoietic Cell Transplantation

Abstract

BackgroundThe prevalence of age-related impairments in older patients (pts) undergoing hematopoietic cell transplantation (HCT), and its relationship with transplant outcomes is largely unknown.MethodsIn a pilot quality improvement project, assessment of functional, social, emotional, cognition, sensory, nutritional and polypharmacy domains was performed using an electronic rapid fitness assessment (eRFA) developed at MSKCC (Shahrokni JNCCN 2017). Older adults (age ≥ 60 years) undergoing HCT for hematologic malignancies from 2015 through 2018 in 2 transplant clinics were included. The prevalence of geriatric impairments, transplant-associated toxicities and survival were analyzed under an IRB approved waiver of authorization.ResultsPatient characteristics are shown in Table 1. The median day from eRFA to HCT was 45 days (range 14-162). Median time to complete eRFA was 10 minutes. Table 2 has a summary of geriatric impairments. Majority of pts (n=33) had at least 1 impairment. The most prevalent were social, emotional, polypharmacy and functional. Median number of geriatric impairments per patient was 4 (range 0-9). Median toxicities per patients was 4 (range 0-12). The most common toxicities were: 25 metabolic, 22 infections, 21 oral/gastrointestinal, and 16 cardiopulmonary. The only pt admitted to the ICU was an allo-HCT pt with 5 impairments. Amongst the 8 pts (4 AHCT, 4 allo-HCT) readmitted to the hospital within the first 100 days of HCT, the median number of impairments was 4 (range 0-9). Seven patients died, 5 from disease, and 2 from GvHD. With a median follow up of 9 months (range 1-38) among survivors, the 18-months progression-free and overall survival were 0.71 (0.55-0.91) and 0.7 (0.51-0.95) respectively (Figure 1).ConclusionsPerforming pre-HCT eRFA among older transplant patients is feasible. With the median completion time of 10 minutes, the eRFA can identify geriatric impairments of this vulnerable population. Future larger studies should assess whether these impairments have association with the outcomes, and whether interventions to improve geriatric impairments also improve transplant outcomes. The prevalence of age-related impairments in older patients (pts) undergoing hematopoietic cell transplantation (HCT), and its relationship with transplant outcomes is largely unknown. In a pilot quality improvement project, assessment of functional, social, emotional, cognition, sensory, nutritional and polypharmacy domains was performed using an electronic rapid fitness assessment (eRFA) developed at MSKCC (Shahrokni JNCCN 2017). Older adults (age ≥ 60 years) undergoing HCT for hematologic malignancies from 2015 through 2018 in 2 transplant clinics were included. The prevalence of geriatric impairments, transplant-associated toxicities and survival were analyzed under an IRB approved waiver of authorization. Patient characteristics are shown in Table 1. The median day from eRFA to HCT was 45 days (range 14-162). Median time to complete eRFA was 10 minutes. Table 2 has a summary of geriatric impairments. Majority of pts (n=33) had at least 1 impairment. The most prevalent were social, emotional, polypharmacy and functional. Median number of geriatric impairments per patient was 4 (range 0-9). Median toxicities per patients was 4 (range 0-12). The most common toxicities were: 25 metabolic, 22 infections, 21 oral/gastrointestinal, and 16 cardiopulmonary. The only pt admitted to the ICU was an allo-HCT pt with 5 impairments. Amongst the 8 pts (4 AHCT, 4 allo-HCT) readmitted to the hospital within the first 100 days of HCT, the median number of impairments was 4 (range 0-9). Seven patients died, 5 from disease, and 2 from GvHD. With a median follow up of 9 months (range 1-38) among survivors, the 18-months progression-free and overall survival were 0.71 (0.55-0.91) and 0.7 (0.51-0.95) respectively (Figure 1). Performing pre-HCT eRFA among older transplant patients is feasible. With the median completion time of 10 minutes, the eRFA can identify geriatric impairments of this vulnerable population. Future larger studies should assess whether these impairments have association with the outcomes, and whether interventions to improve geriatric impairments also improve transplant outcomes.