The Transplant Optimization Program (TOP): Implementing a geriatric assessment (GA)-guided interdisciplinary clinic (IDC) prior to allogeneic hematopoietic cell transplantation (HCT) in older adults.

Abstract

7045 Background: Limitations found on GA correlate with worse outcomes after HCT, but no data exists on prospectively utilizing GA prior to HCT. We established the TOP IDC in March 2013 to implement a cancer-specific GA and an IDC to risk-stratify HCT candidacy and create an individualized care plan for allograft candidates 60+ yrs. Methods: The IDC consisted of a HCT physician, advanced practice provider, dietician, PT/OT, social worker, ID physician, and a geriatric oncologist to devise a pt specific optimization strategy. We compared consecutive HCT pts ≥ 60 years undergoing GA prior to TOP implementation (pre-TOP) from 2005-2012 (n=75) to TOP pts from 2013-2018 (n=86). Results: 3/89 HCT pts 60+ yrs who did not attend TOP were excluded; all 3 died before 1 year post-HCT. Compared with controls, the TOP group was older (median age 67 vs. 64 yrs, p<0.001) but was similar in HCT-CI ≥ 3 (37% vs. 48%, p=0.2), use of myeloablative regimens (20% vs. 19%, p=0.8), and advanced ASBMT risk disease (46% for both). Relative to the pre-TOP group, TOP pts at baseline had fewer impairments in independent activities of daily living (30% vs. 48%, p=0.02) and fewer frail 4-meter walk tests (7% vs. 31%, p<0.001). Pts undergoing optimization in TOP fared better versus pre-TOP (Table). 1-yr non-relapse mortality (NRM) and 1-yr overall survival (OS) continued to improve including 11% NRM and 89% OS in 2017. Conclusions: A GA-guided interdisciplinary optimization clinic for allograft recipients age 60+ reduced transplant associated morbidity and mortality, with marked improvements in NRM and OS over time. A GA-based IDC can facilitate selection and optimization of older pts considering HCT.[Table: see text]