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Introduction/Methods The trajectory of functional decline and the prevalence of geriatric syndromes have not been examined among long-term survivors of older allo-HCT recipients. We previously described significant burden and adverse impact of post-transplant geriatric syndromes, delirium and fall, among older allogeneic recipients. We report here theprevalence and impact of geriatric syndromes in 2-year, progression-free survivors among this cohort of patients using our institutional database. Baseline characteristics, transplant outcomes, geriatric assessment domains, and geriatric syndromes were obtained and analyzed as previously described. Results We identified 199 2-year, progression-free survivors of patients allografted at age ≥60 years from 2001 to 2016, including 111 out of 241 patients on the CD34+ selection platform (46%), and 88 out of 231 T-cell replete patients (38%). The median age at allo-HCT was 65.4 years (range 60 – 78.7); 73% had myeloid malignancies; 69% had high/very high risk HCT-CI/age; 14% had a mismatched donor; and 56% had a CD34+ selected graft. With a median follow-up of 5.7 years for survivors, the 3-yr OS and RFS from the 2-year landmark was 86% (95% CI, 80 – 91) and 83% (95% CI, 78 – 89). Thirty-three patients died, including 8 from relapse/disease progression, and 25 from non-relapse mortality (6 each from secondary neoplasm, organ failure, and infections). The 3-year cumulative incidence of new functional impairment (FI), defined as new admission to skilled nursing facility, fall, or assisted walking device from the 2-year landmark, was 20% (95% CI, 15 – 27). In addition, the 3-year cumulative incidence of new psychiatric illness and cognitive decline was 6% (95% CI, 3 – 11) and 5% (95% CI, 3 – 10), respectively (Figure 1). We examined factors associated with new FI and found that, among others, patients who were transplanted with a CD34+ selected graft had lower incidence of new FI in univariate (hazard ratio [HR]=0.49, 95% CI 0.28 – 0.86, P=0.014) and multivariate analysis with borderline significance (HR=0.53, 95% CI 0.27 – 1.02, P=0.056). In 2-year landmark analyses, both high/very high HCT-CI/age index and mismatched donor were significantly associated with inferior OS and RFS (Table 1). Conclusion While limited by the single institution, retrospective design, heterogenous transplant approach, and likely under-reporting, our findings nevertheless illustrate the high prevalence of FI among older allo-HCT survivors, which maybe attenuated by the CD34+ selection platform. In addition, the impact of graft-versus-host disease on the development of geriatric syndromes merits closer examination. While requiring prospective confirmation, long-term functional impairment should be considered as an important secondary outcome when comparing curative strategies to other less intense approaches in older patients with hematologic malignancies.

Background The prevalence of age-related impairments in older patients (pts) undergoing hematopoietic cell transplantation (HCT), and its relationship with transplant outcomes is largely unknown. Methods In a pilot quality improvement project, assessment of functional, social, emotional, cognition, sensory, nutritional and polypharmacy domains was performed using an electronic rapid fitness assessment (eRFA) developed at MSKCC (Shahrokni JNCCN 2017). Older adults (age ≥ 60 years) undergoing HCT for hematologic malignancies from 2015 through 2018 in 2 transplant clinics were included. The prevalence of geriatric impairments, transplant-associated toxicities and survival were analyzed under an IRB approved waiver of authorization. Results Patient characteristics are shown in Table 1. The median day from eRFA to HCT was 45 days (range 14-162). Median time to complete eRFA was 10 minutes. Table 2 has a summary of geriatric impairments. Majority of pts (n=33) had at least 1 impairment. The most prevalent were social, emotional, polypharmacy and functional. Median number of geriatric impairments per patient was 4 (range 0-9). Median toxicities per patients was 4 (range 0-12). The most common toxicities were: 25 metabolic, 22 infections, 21 oral/gastrointestinal, and 16 cardiopulmonary. The only pt admitted to the ICU was an allo-HCT pt with 5 impairments. Amongst the 8 pts (4 AHCT, 4 allo-HCT) readmitted to the hospital within the first 100 days of HCT, the median number of impairments was 4 (range 0-9). Seven patients died, 5 from disease, and 2 from GvHD. With a median follow up of 9 months (range 1-38) among survivors, the 18-months progression-free and overall survival were 0.71 (0.55-0.91) and 0.7 (0.51-0.95) respectively (Figure 1). Conclusions Performing pre-HCT eRFA among older transplant patients is feasible. With the median completion time of 10 minutes, the eRFA can identify geriatric impairments of this vulnerable population. Future larger studies should assess whether these impairments have association with the outcomes, and whether interventions to improve geriatric impairments also improve transplant outcomes.