Link Between Cognitive Impairment and Outcomes in Older Recipients of Allogeneic HCT?
Posted: Tuesday, September 8, 2020
Cognitive impairment appears to be associated with inferior overall survival by increasing nonrelapse mortality in patients who received allogeneic hematopoietic stem cell transplantation (alloHCT) for AML treatment. Andrew Artz, MD, MS, of the City of Hope Comprehensive Cancer Center in Duarte, California, and colleagues published the results of their retrospective study in Blood Advances.
“These data suggest that the routine assessment of cognitive impairment in older patients preparing to undergo alloHCT may aid in risk-stratification and may even encourage alloHCT in older adults lacking cognitive impairment,” concluded the authors.
Researchers focused on data for 300 patients from 6 transplant centers using the Center for International Blood and Marrow Transplant Research database. Patients were included based on the availability of geriatric assessment data, including independent activities of daily living, and if they were older than 50. Other geriatric measures used in the analysis included the Medical Outcomes Study Physical Health score, Timed Up and Go, and cognition by Blessed Orientation Memory Concentration.
Study patients had frequent impairments on geriatric assessment, including 36% with at least one impairment in their activities of daily living, 14% with a Timed Up and Go longer than 13.5 seconds, and 17% with cognitive impairment. Neither impairments in independent activities of daily living nor age was associated with nonrelapse mortality or overall survival. However, impaired cognition was independently associated with 1-year nonrelapse mortality (subdistribution hazard ratio = 2.19). In addition, a Hematopoietic Cell Transplant-Comorbidity Index score of at least 3 also led to an increase in nonrelapse mortality (subdistribution hazard ratio = 2.36). Cognitive impairment similarly led to an inferior 1-year overall survival (hazard ratio = 1.94). In addition, subgroup analysis of patients older than 60 showed that cognitive impairment was the lone geriatric assessment metric to predict nonrelapse mortality (subdistribution hazard ratio = 2.73).
Disclosure: For a full list of authors’ disclosures, visit ashpublications.org.