Prospective study of longitudinal geriatric assessment with risk-adapted interventions for older patients in allogeneic hematopoietic cell transplantation

Older patients are increasingly considered for higher-intensity, potentially curative therapy such as allogeneic hematopoietic cell transplantation (alloHCT). While comprehensive geriatric assessment (GA) can help identify important vulnerabilities, it remains unknown whether GAguided management interventions could improve outcomes in alloHCT. We conducted a single center, phase II study of a comprehensive, GA-driven, risk-adapted strategy for older patients (≥60 years old) undergoing first alloHCT. Based on pre-transplant GA, robust patients received myeloablative while vulnerable patients received reduced-intensity conditioning. The geriatrics team followed patients longitudinally and provided individualized, GA-directed management. The primary endpoint was one-year non-relapse mortality (NRM) of 10% compared to historical rates of 25%, for a cohort of 32 patients with median age of 69.3 years. The study met the primary endpoint with one-year NRM of 6.3% with no unexpected toxicities attributable to the intervention. With a median follow-up of 28.1 months, the two-year overall and progression-free survival was 72% (95% CI 57-89) and 56% (95% CI 41 - 76), respectively. Both patient reported and objective functioning outcomes were stable to improved by 6 to 12 months after alloHCT. We demonstrate here for the first time that a GA-driven, risk-adapted alloHCT approach that incorporates longitudinal GA-directed management may lead to promising, low NRM and patient-centered outcomes important for older patients.