ALBERT

Description: Background: Geriatric deficits in patients with malignancy are predictive of morbidity and mortality. Measuring geriatric deficits provides additional prognostic information not otherwise captured in routine oncology care. Currently, the gap in geriatric-care delivery is the paucity of data demonstrating effective interventions once geriatric deficits are identified. Older adults with hematologic malignancy are understudied and evaluating both the impact of geriatric factors and interventions to improve upon geriatric deficits are warranted. Here we demonstrate the impact of identifying functional impairment and an exercise program among older adults with hematologic malignancy. Methods: This was a single center prospective study of older patients (≥60 years) with hematologic malignancy. Patients actively receiving any therapeutic treatment (chemotherapy, immunotherapy, targeted agents) were enrolled in a six-month exercise program to attenuate functional decline. The Otago Exercise Program (OEP) has been found to be an effective exercise regimen to improve functional balance, muscle strength, and prevent fall-related injury and mortality.1 The OEP is a structured combination of physical therapist prescribed individualized exercise plans with home-based exercise targeted to improve balance and functional decline. Patients enrolled had mild or moderate impairments in physical function, as defined by a score ≤9 on the Short Physical Performance Battery (SPPB). Patients were evaluated at baseline for geriatric deficits (Visit 1), after four months of OEP training (Visit 2), and following two months of self-directed exercise (Visit 3 - end of study) using a standardized Geriatric Assessmpent (GA) tool (CARG GA). The relationship between geriatric deficits and mortality and hospital utilization were analyzed. The change in GA factors over 3 visits were evaluated through a linear mixed model. The proportional hazards model was built to assess the association between Visit 1 GA and overall survival (OS), where OS was defined as time from date of V1 to death, censoring patients who were still alive at time of last follow-up. The generalized linear models were used to link Visit 1 GA with other clinical outcomes such as hospital length of stay (LOS) and the probability of emergency room (ER) visit. Results: Older adults (median age: 75.5; range 62-83) actively receiving chemotherapy for hematologic malignancy were enrolled (n=30). Physical health scores as measured by the MOS-PFS increased significantly at the second visit. [Median MOS-PFS: V1=55 (0-100); V2=70 (30-100), p

Description: Introduction: Since a link between solar radiation, vitamin D production, and decreased colon cancer mortality was established in 1980, there has been increasing interest in vitamin D and cancer, suggesting that higher vitamin D levels improve overall survival, specifically in breast and colorectal cancer (Maalmi H et al, Eur J Canc, May-2014, PMID 24582912), but also in follicular lymphoma (Kelly JL, J Clin Onc, 1-May-2015, PMID 25823738). In myeloma, largest published series is from the Mayo Clinic reporting on 148 newly diagnosed MM patients for which no survival association was found, but there were associations between low 25-OH-Vit D (

Description: A geriatric assessment (GA) is a global approach to improve healthy aging, wherein occult problems are assessed and intervened upon using a multidisciplinary method. A GA is feasible and can predict chemotherapy-induced toxicity and overall survival in cancer patients. Biomarkers of aging are also being explored as objective and reproducible measures of health and fitness. p16INK4a (p16) is a marker of cellular senescence that rises exponentially with chronologic age and is influenced by factors such as physical activity, smoking, and solid tumor chemotherapy. Here, we investigated the relationship of both the GA and molecular (i.e. p16) metrics in pre-bone marrow transplant (BMT) multiple myeloma (MM) patients. We selected this group for our studies as BMT patients are a vulnerable cohort in which transplant eligibility is subjective and age related. BMT patients are also at high risk for adverse events and treatment toxicity. In this preliminary analysis, we explored the predictive value of GA metrics and p16 with inpatient length of stay (LOS) during autologous BMT. Methods: We performed a pilot prospective cohort study on 55 MM patients during their pre-transplant evaluation. MM patients 〉18 years completed GA assessments related to physical function, distress, comorbidities, social support, and cognition. Patients completed surveys using the Brief Fatigue Inventory (BFI) (scale 1-10; moderate fatigue 4-6, severe fatigue 7+); Hospital Anxiety and Depression (HADS) (borderline case 8-10, definite case 11+); medical outcome study-social support survey (MOS-SSS) (scale 0-100, higher scores indicated greater support), Human Activity Profile (HAP) maximum activity score (MAS) and HAP-adjusted activity score (AAS), a 94-item questionnaire ranking tasks according to energy use validated in the BMT population, with higher scores indicating higher activity (Herzberg BBMT 2010). Objective measures of physical activity were measured using the Short Physical Performance Battery (SPPB) (range 0-12; impairment

Description: Background: Exercise programs are proven to positively impact physical fitness, quality of life, and late toxicities in cancer patients, and many recent reports document the benefit of exercise in patients with diverse cancers.1-3 However, such programs are underutilized in patients with hematologic malignancy.2,3 As anemia and thrombocytopenia associated with hematologic diseases are risk factors for falls and bleeding complications, exercise has not been routinely recommended. Thus, exercise programs have yet to gain traction in patients with hematologic malignancy and are rarely seen as a preventative measure for functional decline. Of critical importance, functional decline is not an inevitable part of illness or aging and is potentially modifiable.4,5 Here, we identified older adults with functional decline and incorporated a preventative exercise program to attenuate complications associated with disease- and therapy-related de-conditioning. Methods: This is a single center, pilot prospective study of older adults (≥60 years) with hematologic malignancy actively receiving chemotherapy. Patients enrolled had mild or moderate impairments in physical function, as defined by a score ≤9 on the Short Physical Performance Battery (SPPB). The SPPB is an objective, validated tool used to capture at risk patients and has been shown to be prognostic in predicting decline in function, re-hospitalization, and mortality.6 The primary objective was to assess the feasibility of implementing a structured exercise program; including recruitment and retention, adherence, sustainability, adverse events and implementation challenges. Reasons why patients decline exercise participation were also tracked. The Otago Exercise Program (OEP) has been found to be an effective exercise regimen to improve functional balance, muscle strength, and prevent fall-related injury and mortality.8 The OEP is a structured combination of physical therapist prescribed individualized exercise plans with home-based exercise, demonstrated to improve balance and functional decline.9 The OEP focuses on strengthening, balance retraining, and walking. Results: Older adults actively receiving chemotherapy with a median age of 75.5 (62-83) with hematologic malignancy (myeloma=18, NHL=6, leukemia=5) were enrolled. Chemotherapy regimens were variable (e.g. R-EPOCH, venetoclax, IMiDS, proteasome inhibitors, bone marrow transplant). Patients were approached (n=63) for participation of a structured exercise program and a target accrual of n=30 was achieved over 17 months. Reasons for declining participation included travel (n=13), inconvenience (n=12), not appropriate (n=5) or concern for side effects/cost/uninformed (n=3). There was no relationship with distanced traveled and exercise completion, R=-0.01 (p=0.94). Adherence was excellent with all 8 sessions complete (n=18) or 7 sessions complete (n=4), at time of analysis. Geriatric assessment factors were analyzed at baseline (Visit 1) and following 4 months of exercise (Visit 2). Physical health scores as measured by the MOS-PFS increased significantly [MOS-PFS: V1=55 (0-100), V2=67.5 (30-100), p=0.005], where patient reported KPS were similar [KPS V1=80 (40-100), V2=85 (60-100), p=0.065]. Importantly, objective measures of physical function improved to normal scores by visit 2 [SPPB V1=7(0-11), V2=11(2-12), p

Description: Abstract 603 Background and Objectives: Cancer or aggressive cancer therapy induced cognitive dysfunction is receiving increased attention as a survivorship issue due to its potential to impact occupational, social, and scholastic activities. Neuropsychological functioning has been investigated previously in patients with hematological malignancies undergoing Autologous Hematopoietic Stem Cell Transplantation (AuHSCT); however, only a couple of studies have had samples that included patients specifically with multiple myeloma (MM). The objectives of this study were to: 1) report the incidence of cognitive deficits in patients with MM post-induction (pre- AuHSCT) and post-AuHSCT; 2) present changes in deficits based on patients' performance on a battery of key cognitive tests 1 month and 3 months post-AuHSCT; 3) identify sub-groups of patients that may be vulnerable to cognitive decline, and 4) present a comparative evaluation of patient's objective performance with their subjective self-appraisal of cognitive function pre- and post-AuHSCT. Methods: Patients were recruited from the University of Texas MD Anderson Cancer Center, Houston, Texas if they: 1) had a confirmed diagnosis of MM; 2) were ≥ 18 years old, and 3) had received induction therapy and been approved to receive AuHSCT. Neuropsychological tests designed to measure multiple cognitive domains were administered pre-AuHSCT and at 1 and 3 months post-AuHSCT. Tests included the evaluation of attention, psychomotor speed, learning and memory, language, and executive function. Patients' symptoms were assessed using the MD Anderson Symptom Inventory Multiple Myeloma Module (MDASI-MM). Results: Approximately 46% of patients exhibited cognitive impairment post induction (pre-AuHSCT) (n =48), 37.8% at 1 month post-AuHSCT (n =37), and 32.4% at 3 months post-AuHSCT (n = 34). Pre-AuHSCT, impairments were higher in learning and memory, language, and executive function relative to other domains. Older patients, minorities, those with less education, and those with more comorbidities were significantly more likely to have cognitive deficits (all P's

Description: Introduction: Hypogonadism, i.e. low total testosterone, is present in approximately a quarter of men older than 70 years (Harman SM et al, J. Clin Endo & Met, 2001, PMID 11158037 and Wu FCW et al, J Clin Endo & M et, 2008, PMID 18270261). Myeloma patients are known to suffer from fatigue and decreased functional performance, mood disturbances, and anemia; similar trends have been found in people with hypogonadism. Cytogenetically high risk myeloma characterized by the amplification of 1q21 is associated with increased serum levels of soluble IL-6 receptor (sIL-6r) (Stephens OW, Blood, 2012, PMID 22072558). We hypothesized that total testosterone levels will be associated with overall survival from the time of diagnosis, presence of 1q21 amplification by CD138-selected FISH, anemia, and anti-depressant use. Methods: The Buckeye Myeloma Registry (OSU 10115) opened in 2011 to enroll any patient with a plasma cell dyscrasia. Serum total testosterone was measured at the time of the initial clinic visit to the myeloma group at Ohio State. Less than 325 ng/dL was defined as the hypogonadal range, and testosterone was divided into 60. Among male MM patients, log-rank [Mantel-Cox] analysis of overall survival with serum testosterone including all 4 groups demonstrated no significant differences (p=0.917) with only 80 events. Among 275 male MM patients with cytogenetic information available, there was no correlation between presence of 1q21 trisomies or tetrasomies and overall survival (r=0.0714, p=0.238). There was a strong and expected correlation between testosterone and BMI (r=0.14, p=0.00468). Among 161 total female MM patients, log-rank analysis with serum testosterone including all 3 groups also demonstrated no differences (p=0.416) with only 29 events in total. Among 101 females with cytogenetic information, there was also no correlation with 1q21 amplification (r=0.0895, p=0.373). Conclusion: The majority of male MM patients (74%) have secondary hypogonadism and approximately half have total testosterone levels