Geriatric assessment before reduced intensity conditioning allogeneic hematologic stem cell transplantation in elderly patients

Introduction: A growing number of patients with hematological malignancies over the age of 65 years are considered for more intensive treatment. Elderly patients represent a heterogeneous population in which the decision to proceed to a reduced intensity conditioning allogeneic hematologic stem cell transplantation (RIC-AHSCT) is often difficult to assess because of more comorbidities and frailty. Objectives: The present studydescribes a population of patients older than 65 years who received a geriatric assessment before a RIC-AHSCT. Methods: During 2013 we have systematically carried out geriatric consultations, usingwell-validated international scales for elderly patients whowere considered for RIC-AHSCT by the transplant physician. Patients were evaluated before the start of the conditioning regimen by functional ability (ADL, IADL), nutritional status (weight loss, Mini Nutritional Assessment, albuminemia), socio environmental circumstances, cognition and mental health (minCOG and/or Mini Mental State Examination), mobility and pain. Comorbidities were also listed for each patient. Results: From February to December 2013, 28 patients over the age of 65 years (19 men, 9 women) with a median age of 68.5 years (range 65– 73 years) were considered for RIC-AHSCT. All patients had hematological malignancieswithmostly diagnoses of acute leukemiamyeloproliferative and myelodysplastic syndromes and were evaluated by a geriatric physician. The geriatric assessment resulted in functional disability in 28.6%of patients,malnutrition in 46%of patients anda risk ofmalnutrition in 25% of patients, a socio environmental risk in 18% of patients, cognitive impairment in 3.6% of patients and suspicion of cognitive impairment in 14% of patients, mobility impairment in 35% of patients, pain in 25% of patients, and thymic disorders in 35.7% of patients. Conclusion: In our knowledge, this is the first study that evaluates elderly patients who pretend to RIC-AHSCT. In this descriptive study 75% of patients with hematological malignancies considered for RIC-AHSCT were fit, 18% were vulnerable and 7% were frail. Up to now, for our knowledge the geriatric assessment has no impact on the decision of the transplant physician. With regard to the growing age of patients, the advances in treatment and supportive care will need a better collaboration between geriatrician and hematologist to optimize patient care. Further studies are necessary to assess the impact of geriatric assessment before RIC-AHSCT. Disclosure of interest: None declared.