The use of comprehensive geriatric assessment in older patients before allologeneic hematopoietic stem cell transplantation: A cross-sectional study

Abstract

ObjectivesTo evaluate the results of the comprehensive geriatric assessment (CGA) before allogeneic hematopoietic stem cell (HSCT) transplantation in patients aged 60 years and over. MethodsWe evaluated all consecutive patients undergoing CGA before HSCT between September 2011 and July 2018 in a private hospital in Brazil. We also evaluated the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-SCI) and the Disease Risk Index (DRI). ResultsDuring the study period, 61 patients were referred for transplant evaluation. After exclusions, we analyzed 40 patients, with a mean age of 67.6 years (60–76). The CGA detected vulnerability and frailty in 43% and 18.9% respectively according to the Fried Frailty Phenotype score; limitations across the domain of function and disability with handgrip test alterations in 65.8%. However, 36 (90%) were independent for instrumental activities of daily living (IADL). Cognitive and depression domain have shown abnormal with the clock test in 44.4%, and loss of memory complains in 37.5%. But the mini-mental test was normal in 89%. Geriatric Depression Scale (GDS) was normal in 82.5%. 30% were considered at risk for malnutrition. Half of the patients (50%) had a high Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score. 32.5% needed ICU admission. The overall survival and non-relapse mortality at 2 years were 41.8% and 38.7% respectively. ConclusionThe CGA was feasible in detecting the patients' vulnerabilities in our population. More studies, multicentric and with a larger number of patients, are needed to evaluate the role of CGA in this context of allo-HCT in our population.