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Artz AS. Biologic vs physiologic age in the transplant candidate. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:99-105. [PMID: 27913468 PMCID: PMC6142444 DOI: 10.1182/asheducation-2016.1.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Hematopoietic cell transplantation (HCT) remains a cornerstone of treatment of many hematologic malignancies but transplant-associated morbidity and mortality limit application to older patients. Biologic or chronologic age barriers to HCT have fallen, because patients in their 8th decade of life comprise the group with the greatest rise in transplant use over the past decade. Evaluating physiologic age or general health in older transplant candidates requires a systematic approach inclusive of functional and comorbidity assessment, which typically is accomplished through geriatric assessment (GA). GA incorporates measures of comorbidity, function, nutrition, social support, and other health-related domains to better describe physiologic age. Older allogeneic transplant patients have a surprisingly high prevalence of vulnerabilities by GA prior to transplant, and significant comorbidity or functional limitations heighten the risks of transplant-related mortality. Ultimately, incorporation of physiologic age can improve estimates of nondisease life expectancy, prognostic survival after HCT, and inform HCT candidacy. Future research on the optimal tools to characterize physiologic age and appropriate interventions in the context of transplant are needed.
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Affiliation(s)
- Andrew S Artz
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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Blaes A, Konety S, Hurley P. Cardiovascular Complications of Hematopoietic Stem Cell Transplantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:25. [PMID: 26909819 PMCID: PMC4766226 DOI: 10.1007/s11936-016-0447-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Liuu E, Caillet P, Curé H, Anfasi N, De Decker L, Pamoukdjian F, Canouï-Poitrine F, Soubeyran P, Paillaud E. [Comprehensive geriatric assessment (CGA) in elderly with cancer: For whom?]. Rev Med Interne 2016; 37:480-8. [PMID: 26997159 DOI: 10.1016/j.revmed.2016.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/17/2015] [Accepted: 02/20/2016] [Indexed: 12/27/2022]
Abstract
Scientific societies recommend the implementation of a comprehensive geriatric assessment (CGA) in cancer patients aged 70 and older. The EGA is an interdisciplinary multidimensional diagnostic process seeking to assess the frail older person in order to develop a coordinated plan of treatment and long-term follow-up. Identification of comorbidities and age-induced physiological changes that may increase the risk of anticancer treatment toxicities is essential to better assess the risk-benefit ratio in elderly cancer patients. The systematic implementation of a CGA for each patient is difficult to perform in daily practice. Therefore, it is recommended to screen vulnerable patients who will benefit from a complete CGA. Our work presents the vulnerability screening tools validated by at least two independent studies in a cancer elderly population setting. Among seven screening tools, the G8 and the VES13 are the most effective, and have been validated specifically in older population with cancer. The G8 is recommended by scientific societies and the French National Cancer Institute (INCa) because of its easy implementation in daily clinical practice, its high sensitivity and fair specificity. Although studies are underway to improve its performance, the G8 is currently the simplest tool to routinely identify older cancer patients who should have a complete assessment in geriatric oncology.
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Affiliation(s)
- E Liuu
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France
| | - P Caillet
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France
| | - H Curé
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Medical oncology department, Grenoble university hospital, CS 10127 Grenoble, France
| | - N Anfasi
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - L De Decker
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Department of internal medicine and geriatrics, Nantes university hospital, 44093 Nantes, France
| | - F Pamoukdjian
- Unité de coordination en oncogériatrie, hôpital Avicenne, AP-HP, 93000 Bobigny, France
| | - F Canouï-Poitrine
- CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Service de santé publique, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - P Soubeyran
- Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France; Institut Bergonié, université de Bordeaux, CS 61283 Bordeaux, France
| | - E Paillaud
- Département de médecine interne et de gériatrie, hôpital Henri-Mondor, AP-HP, UCOG Île-de-France Paris-Sud, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; CEpiA (clinical epidemiology and ageing) unit EA 4393, université Paris Est Créteil, A-TVB DHU, 94014 Créteil, France; Membres du conseil scientifique et du bureau de la SoFOG, 63122 Ceyrat, France.
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Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer Biol Med 2015; 12:261-74. [PMID: 26779363 PMCID: PMC4706523 DOI: 10.7497/j.issn.2095-3941.2015.0082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/21/2015] [Indexed: 01/18/2023] Open
Abstract
The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment (GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.
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Affiliation(s)
- Beatriz Korc-Grodzicki
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Holly M Holmes
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Armin Shahrokni
- 1 Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, USA ; 2 Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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Muffly L. Patient selection for allogeneic hematopoietic cell transplantation (HCT): the evolution of HCT risk assessment. Curr Hematol Malig Rep 2014; 10:28-34. [PMID: 25500987 DOI: 10.1007/s11899-014-0241-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of allogeneic hematopoietic cell transplantation is expanding, with disproportionate growth witnessed in older adults with hematologic malignancies. As the chronological age barrier to transplant fades, refining the pre-hematopoietic cell transplantation (HCT) risk assessment to better capture host health status and disease characteristics is essential. This review summarizes recent efforts to move the field forward towards achieving this goal. Many of these risk assessment tools are currently included in prospective clinical trials; routine clinical use requires greater understanding of how to best incorporate this new information into HCT decision making.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, 300 Pasteur Drive, H0144B, Stanford, CA, 94305-5623, USA,
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