Hematopoietic Stem Cell Transplantation in the Elderly: Nutritional and Geriatric Assessment

Introduction: Hematopoietic stem cell transplantation (HSCT) may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. Being in some diseases the only curative option. HSCT in elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients.

Objectives: To study and correlate nutrition and geriatric assessment in elderly patients undergoing HSCT.

Methods: A retrospective study of 17 elderly patients (>60 years) undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. All patients were evaluated approximately one month prior to HSCT. In the geriatric assessment were done hand-grip strength(HGS), questions about mobility and functional limitation. In the nutrition, we studied the Body Mass Index(BMI) (kg/m²), and serum levels of vitamin D, zinc and albumin.

Results: 17 elderly patients were observed in this study, mean age was 65,5±3,8 years, BMI was 28±6,0 kg/m², HGS was 28±8,5 kg; serum levels of albumin 3,2±0,5g/dl(normal:3,5-5,0); serum level of vitamin D 23,4±14 ng/ml (normal >20); serum levels of zinc 65,5±18 mg/dl (normal: 66-132,5 mg/dl). We found the negative correlation between BMI and HGS (r_p=0,42)_. There were a significant and positive association between serum levels of zinc and albumin, and HGS and grades of mobility questions(p<0,05). The serum levels of vitamin D weren`t significantly associated with geriatric factors.

Conclusion: Our study showed that the obese patients with more risks of complications in HSCT had more functional limitation. Besides low levels of zinc and albumin were associated with worst results in the geriatric assessment. In the elderly the immobility and weakness can increased the complications after HSCT. The geriatric and nutrition assessment are important to improve HSCT results.