Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis.

Allogeneic hematopoietic cell transplantation (alloHCT) in older patients requires the weighing of risks and benefits for this potentially curative treatment while facing age-related limitations. Comprehensive geriatric and quality of life (EORTC QLQ C-30) assessements (CGA/QOL) in addition to disease-specific data were obtained in 108 consecutive patients (≥60 years) pre-HCT, at day +30, +100, and +180. Median follow-up of 106 patients alive at alloHCT was 43.5 months, median age 66 years (range 60-78). Eighty-six (81.2%) had advanced disease risk at HCT and 99 (91.7%) patients received reduced intensity conditioning (RIC). Median PFS was 13.4 months with 38.3% (95% CI: 28.6-47.4) alive and in remission at 2 years; median OS was 15.6 months with 43.9% (95% CI: 34.3-53.4) alive at 2 years. Prognostic factors for PFS were: age: HR 1.084 (95% CI: 1.032-1.137, p = 0.0011); HCT-CI: HR 1.13 (95% CI: 1.001-1.274, p = 0.048); for OS: age: HR 1.08 (95% CI: 1.031-1.139, p = 0.0017), Karnofsky Index: HR 0.97 (95% CI: 0.954-0.996, p = 0.02); EORTC QLQ C-30 fatigue: HR 1.09 (95% CI: 1.004-1.185, p = 0.039); Up-and-Go: HR 3.26 (95% CI: 1.001-10.6, p = 0.049). Follow-up assessments as time-dependent covariates were highly prognostic for OS and PFS. CGA/QOL confer additional prognostic utility in older alloHCT recipients.