Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease

Areej El-Jawahri, Joseph Pidala, Yoshi Inamoto, Xiaoyu Chai, Nandita Khera, William A. Wood, Corey Cutler, Mukta Arora, Paul A. Carpenter, Jeanne Palmer, Mary Flowers, Daniel Weisdorf, Steven Pavletic, Samantha Jaglowski, Madan Jagasia, Stephanie J. Lee, Yi Bin Chen

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

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 40years; "middle-aged," 41 to 59years; and "older,"≥60years) 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.

Original languageEnglish (US)
Pages (from-to)1341-1348
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number9
DOIs
StatePublished - Sep 2014

Bibliographical note

Funding Information:
This work was supported by grants CA118953 and CA163438 from the National Institutes of Health . The Chronic GVHD Consortium (U54 CA163438) is a part of the NIH Rare Diseases Clinical Research Network, supported through collaboration between the NIH Office of Rare Diseases Research at the National Center for Advancing Translational Sciences , the National Cancer Institute , and the Fred Hutchinson Cancer Research Center . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

  • Age
  • Chronic graft-versus-host disease
  • Functional status
  • Quality-of-life

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