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Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant.

ABSTRACT: Multiple myeloma (MM) is a disease of aging adults and autologous stem cell transplant (ASCT) is considered the standard of care. As the population ages a growing number of older adults will undergo ASCT and an objective approach to estimate physiologic reserve and transplant morbidity risk is warranted. Here, we evaluate assess p16INK4a (p16), a molecular aging biomarker, along with geriatric metrics to determine risk of transplant toxicity. METHODS:We prospectively evaluated 100 MM patients for frailty before and after ASCT using a Geriatric Assessment (GA) and collected T-cells for analysis of p16 using a custom nanostring codeset. RESULTS:Pre-transplant physical function was predicative of hospital length of stay (LOS). Each one-unit increase in physical function score, the average LOS decreased by 0.52?days (95% CI, -1.03-0.02); p?=?.04). Similarly, higher self-report of ADL/IADL (Human Activity Profile was associated with shorter LOS (0.65 less days (95% CI -1.15 to -0.15), p?=?.01). Patients with anxiety/depression (OR?=?1.10 (95% CI 1.00-1.22), p?=?.056), lower handgrip strength (OR?=?0.90 (95% CI 0.82-0.98), p?=?.02), falls (OR?=?1.60 (95% CI 1.07-2.38), p?=?.02), or weight loss (OR?=?5.65 (95% CI 1.17-25.24), p?=?.03) were more likely to be re-admitted. The estimated EFS at 1-year was 85% (95% CI, 75-91) with median follow-up of 15.7?months. Weight loss was a significant predictor of EFS (HR?=?3.13 (95% CI 1.15-8.50), p?=?.03). Frailty assessment by self-reported fatigue minimally correlated with T-cell p16 expression (r?=?0.28; p?=?.02). Age, Karnofsky Performance Status (KPS), or Hematopoietic cell transplantation-specific Co-Morbidity Index (HCT-CI) did not predict hospital LOS or readmissions. CONCLUSIONS:Our data illustrate that a GA can identify individuals with MM who are at greater risk for morbidity following ASCT.

SUBMITTER: Rosko AE

PROVIDER: S-EPMC6320732 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant.

Rosko Ashley E AE Huang Ying Y Benson Don M DM Efebera Yvonne A YA Hofmeister Craig C Jaglowski Samantha S Devine Steven S Bhatt Geetika G Wildes Tanya M TM Dyko Alanna A Jones Desirée D Naughton Michelle J MJ Byrd John C JC Burd Christin E CE

Journal of geriatric oncology 20180706 3

Multiple myeloma (MM) is a disease of aging adults and autologous stem cell transplant (ASCT) is considered the standard of care. As the population ages a growing number of older adults will undergo ASCT and an objective approach to estimate physiologic reserve and transplant morbidity risk is warranted. Here, we evaluate assess p16<sup>INK4a</sup> (p16), a molecular aging biomarker, along with geriatric metrics to determine risk of transplant toxicity.<h4>Methods</h4>We prospectively evaluated ...[more]

PMID: 29983352

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Project description:Autologous hematopoietic stem cell transplantation (ASCT) is a standard treatment for multiple myeloma (MM). Consensus guidelines recommend collecting sufficient stem cells in case there is a need for stem cell boost for delayed/poor engraftment or for future second ASCT. However, collecting and storing backup stem cells in all patients requires significant resources and cost, and the rates of backup stem cell utilization are not well studied. We sought to examine the utilization of backup stem cells (BSCs) in patients with MM undergoing ASCT. Patients with MM aged ≥18 years old who underwent first ASCT at our institution from January 2010 through December 2015 and collected sufficient stem cells for at least 2 transplants were included in this single-center retrospective study. This timeframe was selected to allow for adequate follow-up. A total of 393 patients were included. The median age was 58 years (range, 25-73). After a median follow-up of 6 years, the median progression-free survival (PFS) of the cohort was 3 years. Sixty-one percent (n = 240) of patients progressed or relapsed. Chemotherapy-based mobilization was used in almost all patients (98%). The median total CD34+ cells collected was 18.2 × 106/kg (range, 3.4-112.4). A median of 5.7 × 106 CD34+ cells/kg (range, 1.8-41.9) was infused during the first ASCT, and a median of 10.1 × 106 CD34+ cells/kg (range, 1.5-104.5) was cryopreserved for future use. Of the patients, 6.9% (n = 27) used backup stem cells, with 2.3% (n = 10) using them for stem cell boost, 4.6% (n = 18) for a second salvage ASCT, including 1 patient for both stem cell boost and second ASCT. Rates of backup stem cell use among patients aged <60, 60-69, and ≥70 years were 7.8%, 5.7%, and 5.9%, respectively. There was a trend toward higher rates of backup stem cell use for second ASCT in patients who were younger, had suboptimal disease control at time of first ASCT, and longer PFS. The median dose of stem cell boost given was 5.6 × 106 CD34+ cells/kg (range, 1.9-20). The median time from stem cell boost to neutrophil, hemoglobin, and platelet engraftment was 4 (range, 2-11), 15 (range, 4-34), and 12 (range, 0-34) days, respectively. Lower CD34+ dose and older age at time of ASCT predicted need for stem cell boost. With new salvage therapies for relapsed MM, the rates of second ASCT are very low. The low rates of use suggest that institutional policies regarding universal BSC collection and long-term storage should be reassessed and individualized. However, need for stem cell boost in 2.3% of patients may present a challenge to that.

Project description:BACKGROUND:Respiratory complications are the leading cause of morbidity in patients undergoing tracheobronchoplasty, yet risk stratification systems on this population are insufficient. We investigated the association between frailty and risk of major respiratory complications after tracheobronchoplasty. METHODS:A retrospective review was made of 161 consecutive tracheobronchoplasties (October 2002 to September 2016). A frailty index was developed by the deficit-accumulation approach comprising 26 multidomain preoperative variables. The main outcome was a composite endpoint of major respiratory complications within 30 days of surgery. Odds ratio (OR) and 95% confidence interval (CI) were estimated using logistic regression. RESULTS:The cohort consisted of 103 women (64%), median age of 58 years (interquartile range, 51 to 66) and median FI of 0.25 (interquartile range, 0.1 to 0.3). Forty-eight patients (30%) had respiratory complications, the most common being respiratory failure (n = 27, 16.8%) and pneumonia (n = 25, 15.5%). Severe frailty (frailty index ?0.33) was strongly associated with major respiratory complications (73.8% versus 2.5%; OR 58.8, 95% CI: 9.6 to 358.3). The association with severe frailty appeared stronger for respiratory failure (47.6% versus 2.5%; OR 30, 95% CI: 4.7 to 189.9) than for pneumonia (40.5% versus 0%; OR 35.2. 95% CI: 2.0 to 599.8). Further adjustment for intraoperative crystalloid volume or forced expiratory volume in 1 second moderately attenuated the association between frailty with major respiratory complications (OR 17.4. 95% CI: 2.0 to 150.8), respiratory failure (OR 13.1, 95% CI: 1.7 to 95.8), and pneumonia (OR 20.1, 95% CI: 1.1 to 341.8). CONCLUSIONS:Frailty, as indicated by frailty index, was associated with major respiratory complications, particularly respiratory failure after tracheobronchoplasty. Preoperative identification of frailty may help guide decision making for patients considering this effective, although arduous procedure.

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Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant.

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Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant.

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