title: Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease.
abstract: Although older patients undergoing allogeneic hematopoietic stem cell transplantation (HCT) may experience higher morbidity, the impact of chronic graft-versus-host disease (GVHD) on quality of life (QOL) and survival outcomes for older compared with younger patients is currently unknown. We utilized data of patients with moderate or severe chronic GVHD (N = 522, 1661 follow-up visits, a total of 2183 visits) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between age group (adolescent and young adult, "AYA," 18 to 40 years; "middle-aged," 41 to 59 years; and "older," ≥ 60 years) and QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]), physical functioning (Human Activity Profile [HAP]), functional status (2-minute walk test [2MWT]), nonrelapse mortality, and overall survival. Because of multiple testing, P values < .01 were considered significant. This study included 115 (22%) AYA, 279 (53%) middle-aged, and 128 (25%) older patients with moderate (58%) or severe (42%) chronic GVHD. Despite more physical limitations in older patients as measured by worse functional status (shorter 2MWT [P < .001] and lower HAP scores [P < .001]) relative to AYA and middle-aged patients, older patients reported better QOL (FACT-BMT, P = .004) compared with middle-aged patients and similar to AYA patients (P = .99). Nonrelapse mortality and overall survival were similar between the age groups. Therefore, despite higher physical and functional limitations, older patients who are selected to undergo HSCT and survive long enough to develop moderate or severe chronic GVHD have preserved QOL and similar overall survival and nonrelapse mortality when compared with younger patients. Therefore, we did not find evidence that older age is associated with worse outcomes in patients with moderate or severe chronic GVHD.
authors.affiliation: Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: ael-jawahri@partners.org.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pidala
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yoshi
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Chai
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Linenberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
authors.affiliation: Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mary
authors.initials: M
authors.lastname: Flowers
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
authors.affiliation: National Cancer Institute, National Institutes of Health Center for Cancer Research, Bethesda, Maryland.
authors.forename: Steven
authors.initials: S
authors.lastname: Pavletic
authors.affiliation: Division of Hematology-Oncology, Ohio State University Medical Center, Columbus, Ohio.
authors.forename: Samantha
authors.initials: S
authors.lastname: Jaglowski
authors.affiliation: Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Age; Chronic graft-versus-host disease; Functional status; Quality-of-life