Use of a geriatric assessment (GA)-driven, risk-adapted approach to select conditioning intensity for older patients with myeloid malignancies eligible for allogeneic hematopoietic transplantation (alloHCT) effectively reduced the rate of non-relapse mortality (NRM) compared with the historical rate, according to the results of a phase II study presented at the 66th American Society of Hematology Annual Meeting and Exposition.
Richard J. Lin, MD, PhD, of Memorial Sloan Kettering Cancer Center in New York, and colleagues conducted a single-center study assessing the use of a GA-driven, risk-adapted strategy to guide selection of conditioning intensity and supportive care interventions for older patients with myeloid malignancies undergoing alloHCT.
“A GA differentiates patients with similar chronologic age who are biologically younger and more fit who could be considered to take on high-intensity treatment,” Dr. Lin told ASH Clinical News. “It helps to differentiate where people are more vulnerable or frail so we can optimize those patients.”
The study included patients older than 60 who were undergoing first transplant. Patients underwent a pre-transplant GA and, based on the results, were assigned to myeloablative conditioning (n=8) or reduced intensity conditioning (n=24). Specifically, patients with functional impairment, high comorbidity burden, or both received reduced-intensity conditioning. Included patients had acute myeloid leukemia (56%), myelodysplastic syndromes (28%), and myeloproliferative disorders (16%).
The one-year NRM was 6.3%, meeting the primary endpoint of a one-year NRM of 10% or less. There were two events; one patient died of septic shock, and one from immune-mediated cytopenia and hemorrhage.
With a median follow-up of 19.9 months for survivors, one-year progression-free survival was 63%, and one-year overall survival was 78%.
Half of the patients developed acute graft-versus-host disease (GVHD), and 12.5% developed moderate to severe chronic GVHD. The cumulative incidence of relapse at one year was 34.3%; the rate of relapse among those with TP53-mutated disease was 62.5%. Patients who remained in remission at one year post-transplant maintained their physical independence and cognitive functioning based on serial GA.
Dr. Lin said that quality-of-life, biomarker analyses, and long-term follow-ups are ongoing.
According to the researchers, these results “support the inclusion of GA-driven approaches into standard-of-care transplant planning to select and optimize older patients prior to and during transplant, and to enhance their recovery following transplant.”
“If we use this approach to guide conditioning intensity and co-management during the transplant process, this process is feasible and can lead to significantly reduced NRM,” Dr. Lin said. “The take-home message for practitioners is that this should be considered a standard approach for older patients: upfront GA and geriatric co-management throughout the whole transplant process.”
Dr. Lin and colleagues believe that innovative interventions are urgently needed to reduce post-transplant relapse among older patients with higher-risk disease.
Any conflicts of interest declared by the authors can be found in the original abstract.
Reference
Lin RJ, Kim SJ, Brown S, et al. Phase II study of longitudinal geriatric assessment with risk-adapted interventions to reduce non-relapse mortality in allogeneic hematopoietic cell transplantation for older patients with advanced myeloid malignancies. Abstract 686. Presented at the 66th American Society of Hematology Annual Meeting and Exposition; December 8, 2024; San Diego, California.
