Faculty Collaboration Database

Breaking the Age Barrier: Physicians' Perceptions of Candidacy for Allogeneic Hematopoietic Cell Transplantation in Older Adults. Transplant Cell Ther 2021 Jul;27(7):617.e1-617.e7

Date

04/10/2021

Pubmed ID

33836312

Pubmed Central ID

PMC8254775

DOI

10.1016/j.jtct.2021.03.028

Scopus ID

2-s2.0-85106248005 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

Despite continuing increases in the use of allogeneic hematopoietic cell transplantation (alloHCT) in older adults, no standardized geriatric assessment (GA) has been established to risk stratify for transplantation-related morbidity. We conducted a survey of transplant physicians to determine perceptions of the impact of older age (≥60 years) on alloHCT candidacy, and utilization of tools to gauge candidacy. This 23-item online cross-sectional survey was distributed to HCT physicians caring for adults in the United States between May and July 2019. Of the 770 invited HCT physicians, 175 (22.7%) completed the survey. The majority of respondents were age 41 to 60 years and male and practiced in a higher-volume teaching hospital. When considering regimen intensity, 29 physicians (17%) stated they would consider a myeloablative regimen for patients age ≥70 years, and 141 (82%) would consider reduced-intensity/nonmyeloablative conditioning for patients age ≥70 years. Almost all (90%) endorsed the need for a specialized assessment of pre-HCT vulnerabilities to guide candidacy decisions for older adults. Most physicians reported that their centers rarely (33%) or never (46%) use a dedicated geriatrician/geriatric-oncologist to assess alloHCT candidates age ≥60 years. Common barriers to performing a GA included uncertainty about which tools to use, lack of knowledge and training, and lack of appropriate clinical support staff. Many alloHCT physicians will consider alloHCT in patients up to age 75 years and not uncommonly in patients older than that. However, the application of tools and domains to assess candidacy in older adults varies widely. Incorporation of a standardized pretransplantation health assessment tool for risk stratification is a significant unmet need.

Author List

Mishra A, Preussler JM, Bhatt VR, Bredeson C, Chhabra S, D'Souza A, Dahi PB, Hacker ED, Gowda L, Hashmi SK, Howard DS, Jakubowski A, Jayani R, Koll T, Lin RJ, Olin RL, Popat UR, Rodriguez C, Rosko A, Sabloff M, Sorror ML, Sung AD, Ustun C, Wood WA, Burns L, Artz A

Author

Anita D'Souza MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cross-Sectional Studies
Hematopoietic Stem Cell Transplantation
Humans
Male
Middle Aged
Perception
Physicians
Transplantation, Homologous
United States