Optimal screening for geriatric assessment in older allogeneic hematopoietic cell transplantation candidates.
OBJECTIVE
Older patients who receive hematopoietic cell transplantation (HCT) may be at risk for adverse outcomes due to age-related conditions or frailty. Geriatric assessment (GA) has been used to evaluate HCT candidates but can be time-consuming. We therefore sought to determine the predictive ability of two screening tools, the Vulnerable Elders Survey (VES-13) and the G8, for abnormal GA or frailty.


METHODS
We enrolled 50 allogeneic HCT candidates age ≥60 years. The GA included measures of medical, physical, functional, and social health. Frailty was defined as 3 or more abnormalities on grip strength, gait speed, weight loss, exhaustion, and activity. We associated baseline characteristics and abnormal GA or frailty. We determined the sensitivity and predictive ability of the VES-13 and G8 for GA and frailty.


RESULTS
Overall, 33 (66%) patients (mean age 65.4 years) had an abnormal GA, and 11 patients (22%) were frail. The G8 screening tool had a higher sensitivity for an abnormal GA (69.7%), and the VES-13 had a higher specificity (100%). Both tools had similar discriminatory ability.


CONCLUSIONS
Older HCT candidates had a significant number of deficits on baseline GA and a high prevalence of frailty. Existing screening tools may not be able to replace a full GA.
Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: hholmes@mdanderson.org.
Holly M
HM
Holmes
Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jude K A
JK
Des Bordes
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Partow
P
Kebriaei
Department of Palliative Care & Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Sriram
S
Yennu
Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Richard E
RE
Champlin
Memorial Sloan Kettering Cancer Center, USA.
Sergio
S
Giralt
University of Rochester, USA.
Supriya G
SG
Mohile
D000368:Aged; D004185:Disability Evaluation; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data*; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013781:Texas
Elderly; Frailty; Geriatric assessment; Screening tools; Stem cell transplantation