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Enhanced Recovery Stem-Cell Transplantation: Multidisciplinary Efforts to Improve Outcomes in Older Adults Undergoing Hematologic Stem-Cell Transplant
Ngo-Huang, A., Ombres, R., Saliba, R. M., Szewczyk, N., Adekoya, L., Soones, T. N., Ferguson, J., Fontillas, R. C., Gulbis, A. M., Hosing, C., et al
JCO oncology practice. 2023;:Op2200520
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Abstract
PURPOSE Older adults have unique risk factors for poor outcomes after hematopoietic stem-cell transplant (HSCT). We sought to determine the impact of our multidisciplinary supportive care program, Enhanced Recovery after stem-cell transplant (ER-SCT), on survival outcomes in patients age 65 years and older who underwent HSCT. PATIENTS AND METHODS In this retrospective study, clinicodemographic data, nonrelapse mortality (NRM), overall survival (OS), and relapse were compared between 64 patients age 65 years and older who underwent allogeneic stem-cell transplant during ER-SCT program's first year, October 2017 through September 2018, and 140 historical controls age 65 years and older who underwent allogeneic HSCT, January 2015 through September 2017. RESULTS In the ER-SCT cohort, 41% (26 of 64) of patients were women, and the median (range) age was 68 (65-74) years; in the control cohort, 38% (53 of 140) of patients were women, and the median (range) age was 67 (65-79) years. Hematopoietic cell transplant comorbidity index and donor type/cell source were similar between cohorts. The ER-SCT cohort had a lower 1-year NRM rate (13% v 26%, P = .03) and higher 1-year OS rate (74% v 53%, P = .007). Relapse rate did not differ significantly between cohorts. In multivariate analyses, ER-SCT was associated with improved 1-year NRM (hazard ratio, 0.4; 95% CI, 0.2 to 0.9; P = .02) and improved 1-year OS (hazard ratio, 0.5; 95% CI, 0.3 to 0.9; P = .03). CONCLUSION A multidisciplinary supportive care program may improve NRM and OS in older patients undergoing allogeneic HSCT. Randomized studies are warranted to confirm this benefit and explore which program components most contribute to the improved outcomes.
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Feasibility and Implementation of a Multimodal Supportive Care Program to Improve Outcomes in Older Patients Undergoing Allogeneic Stem Cell Transplantation
Szewczyk, N. A., Ngo-Huang, A., Soones, T. N., Adekoya, L. M., Fontillas, R. C., Ferguson, J. K., Gale, H. E., Kurse, B. C., Lindsay, R. J., Ombres, R., et al
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Increasingly, patients 65 years of age or older are receiving allogeneic hematopoietic stem cell transplants. Although age alone is a well-documented predictor of overall survival and non-relapse mortality, growing evidence suggests that poor functional status and frailty associated with aging may also play a role. Our goal was to identify and improve these and other aging-related maladies by developing a multimodal supportive care program for older transplant patients. METHODS We designed and implemented a multimodal supportive care program- Enhanced Recovery in Stem Cell Transplant (ER-SCT)- for patients 65 and older undergoing allogeneic transplantation (allo-SCT). ER-SCT consisted of evaluation and critical interventions by key health care providers from multiple disciplines before hospital admission for transplantation through 100 days post-allo-SCT. We determined the feasibility of implementing this program within a large stem cell transplantation center. RESULTS After one year of ongoing process improvements, multiple evaluations, and enrollment, we found that a dedicated weekly clinic was necessary to coordinate care and evaluate patients early. We have successfully enrolled 57 (89%) of 64 eligible patients in the first year. CONCLUSION A multimodal supportive care program to enhance recovery for older patients undergoing an allo-SCT is feasible.
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Ibandronate for the prevention of bone loss after allogeneic stem cell transplantation for hematologic malignancies: a randomized-controlled trial
Lu, H., Champlin, R. E., Popat, U., Pundole, X., Escalante, C. P., Wang, X., Qiao, W., Murphy, W. A., Gagel, R. F.
BoneKEy Reports. 2016;5:843
Abstract
The purpose of this study was to evaluate the effects of ibandronate on bone loss following allogeneic stem cell transplantation (allo-SCT). A single-centered, open-label prospective randomized-controlled study following allo-SCT. The treatment group received 3mg of intravenous ibandronate quarterly starting within 45 days of allo-SCT. All patients received daily calcium and vitamin D supplements. We compared the changes in bone mineral density (BMD) in the lumbar spine, femoral neck and total hip at 6 and 12 months following allo-SCT between the control and treatment groups. We also assessed relationships between bone loss and cumulative glucocorticoid dose, cumulative tacrolimus dose and acute and chronic graft-versus-host disease (GVHD) by linear regression. In all, 78 patients were enrolled. The treatment group had significantly less BMD loss in the lumbar spine at 6 months (mean percent change 0.06+/-4.03 (treatment group) versus -2.61+/-4.2 (control group)) and 12 months (mean percent change 1.27+/-5.29 (treatment group) versus -1.81+/-4.49 (control group)) than the control group (P=0.03). Both groups lost more BMD in the femoral neck and total hip than in the lumbar spine at 6 and 12 months. The changes in BMD in the femoral neck and total hip did not differ significantly between groups. Both glucocorticoids and tacrolimus reduced BMD in the lumbar spine, but ibandronate prevented this loss. Ibandronate may reduce bone loss in the lumbar spine in patients who undergo allo-SCT, particularly those who have received high doses of glucocorticoids and/or tacrolimus.