18 November 2019

Older patients with blood cancers who are being considered for stem cell transplantation experience better outcomes and survival rates if they undergo a multidisciplinary evaluation first, a US study has found.

Research led by a team at the University of Chicago Medical Center and published last week in the journal Blood Advances demonstrates that patients can achieve better results without any sacrifice in their treatment.

Although haematopoietic cell transplantation (HCT) can be effective for older patients, many doctors are reluctant to refer them for transplant because of the perceived potential complications.

In this study, the clinic aimed to improve patient resilience before transplant so that older patients are not excluded from the treatment based on age alone.

The University of Chicago Medical Center assembled a multidisciplinary clinic (MDC) for patients being evaluated for transplant. The team included transplant physicians, transplant nurse practitioners, geriatricians or geriatric oncologists, infectious disease physicians, dieticians, and social workers.

Patients took self-assessment surveys on their physical, social, and emotional health, plus clinic tests on mobility and cognition. The multidisciplinary team used the results to co-ordinate their recommendations and create integrated and personalised treatment plans.

Researchers found that compared to patients who had undergone transplants at the centre before the MDC was launched, patients in the multidisciplinary setting experienced fewer complications, fewer admissions to nursing facilities, shorter hospital stays, and better survival.

Senior study author Dr Andrew Artz said: “We can help the patient achieve better results without sacrificing the treatment. In the past, physicians might give a lower intensity regimen or not offer transplant as their main treatment option. Now, we can strengthen the patient so we can offer the treatments that best address not only the patient's disease but also their individual needs and goals.”

The researchers say they hope that subsequent randomised controlled studies will confirm the findings. “Our main goal is to allow more older patients who could benefit from transplant to be able to consider it as a treatment option,” added Dr Artz.

 

Source:

Derman BA, Kordas K, Ridgeway J, Chow S, Dale W, Lee SM, Aguada E, Jakubowiak AJ, Jasielec J, Kline J, Kosuri S, Larson RA, Liu H, Mortel M, Odenike O, Pisano J, Riedell P, Stock W, Bishop MR, Artz AS. (2019) “Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults”, Blood Advances, doi: 10.1182/bloodadvances.2019000790