Identifying Best Approach in Improving Quality of Life and Survival After a Donor Stem Cell Transplant in Older, Medically Infirm, or Frail Patients With Blood Diseases


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Trial ID: NCT03870750


This phase II/III trial studies the best approach in improving quality of life and survival after a donor stem cell transplant in older, weak, or frail patients with blood diseases. Patients who have undergone a transplant often experience increases in disease and death. One approach, supportive and palliative care (SPC), focuses on relieving symptoms of stress from serious illness and care through physical, cultural, psychological, social, spiritual, and ethical aspects. While a second approach, clinical management of comorbidities (CMC) focuses on managing multiple diseases, other than cancer, such as heart or lung diseases through physical exercise, strength training, stress reduction, medication management, dietary recommendations, and education. Giving SPC, CMC, or a combination of both may work better in improving quality of life and survival after a donor stem cell transplant compared to standard of care in patients with blood diseases.

Official Title

Seamless Phase II-Phase III Randomized Clinical Trial to Identify and Confirm the Most Promising Novel Intervention to Alleviate Morbidity and Mortality After Allogeneic Hematopoietic Cell Transplantation Among Older, Medically Infirm, or Frail Patients With Hematological Diseases

Stanford Investigator(s)

Laura Johnston
Laura Johnston

Professor of Medicine (Blood and Marrow Transplantation and Cellular Therapy)


Inclusion Criteria:

   - Vulnerable patients as defined by one or more of the following criteria

      - Age 65 years or older

      - Having Hematopoietic Cell Transplantation - Comorbidity Index (HCT-CI) scores of
      >= 3 (for patients that could be 20 years old and older)

      - Having frailty as determined by walk speed of < 0.8 m/s using 4-meter walk test
      (for patients 50 years old and older)

   - Patients considered or referred for allogeneic HCT to treat a hematological malignant
   or non-malignant disease

   - Able to speak and read English - interaction with the interventionist trainer and
   endpoint measurement must occur in English

   - Willing and able to provide informed consent

   - Planned allogeneic HCT within 3 weeks - all types of donors and all sorts of
   conditioning regimens are allowed. Patients with suspected active disease (relatively
   old disease staging or relatively old intervention) or significant comorbidity (e.g.
   suspicious untreated pulmonary nodules) based on prior evaluations, that could delay
   the transplant would be considered for enrollment within a tighter window (10-14 days
   before allogeneic HCT) to allow for completed pre-HCT work-up evaluations that would
   confirm readiness to proceed with transplant

   - Able to exercise at low to moderate intensity, specifically taking into consideration
   the rare circumstances where subjects are not able to exercise due to either birth
   deformity or prior traumatic injury that affects their gait

   - Adequate cardiopulmonary reserve, as judged by data from the patient's electronic
   medical record as to whether a patient could walk up one flight of stairs, no need for
   supplemental oxygen, and/or physician judgment

Exclusion Criteria:

   - Orthopedic, neurologic or other problems which prevent safe ambulation and protocol
   adherence. Information on prior falls and other recent orthopedic or neurologic
   problems will be used to make judgment about protocol eligibility

   - Participation in another intervention clinical trial with HRQOL as a primary endpoint

   - Planned donor lymphocyte infusion (DLI) within 90 days post-transplant

   - Planned anti-cytotoxic therapies, other than tyrosine kinase inhibitors or
   single-agent monoclonal antibody, or FLT-3 inhibitors within 90 days of
   post-transplant unless pre-approved by the protocol principal investigator (PI)


other: Supportive Palliative Care

other: Clinical Management

other: Best Practice

procedure: Allogeneic Hematopoietic Stem Cell Transplantation

other: Questionnaire Administration

other: Quality-of-Life Assessment

other: Survey Administration


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Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Melanie Gaudinez

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