LAUSR

Background The American Geriatric Society has established criteria (Beers criteria) for Potentially Inappropriate Medications (PIMs) in older (65+y) adults (J Am Geriatr Soc. 2019 Apr;67(4):674-694). The use of PIMs in allogeneic hematopoietic cell transplant (allo-HCT) and its impact on outcomes is unknown. Methods The use of PIMs, in defined categories [anticholinergics, central nervous system (CNS), benzodiazepines, gastrointestinal (GI), genitourinary (GU), and narcotics] in older (≥ 65y) allo-HCT recipients were compared to younger recipients [(40-64y undergoing reduced intensity conditioning (RIC)] during initial HCT admission (day-14 to +28 post HCT). Use of PIMs was defined as the number of days a patient received 1 or more PIMs between d-14 to +28. Medications were retrieved from medical records and categorized by Beers criteria for 354 allo-HCT recipients ≥ 40y in 2 groups (40-64y RIC, n=240; and 65+y RIC, n=114). Poisson regression determined the log use of PIMs in the 2 groups. In 65+y group, we evaluated the impact of PIMs on the incidence of CTCAE grade 3 and 4 toxicities; and non-relapse mortality (NRM). All analyses were adjusted or length of hospital stay. Results All PIMs: The median (range) days of all PIMs in 65+y RIC recipients [94 (24-279)] was similar to 40-64y RIC recipients [101 (8-441), p=0.48, confirmed in Poisson regression (Figure 1) [65+y RIC vs 40-64y RIC log change 0.0, p= 1.0). Patients with a high (vs. low) HCT-CI score received more days of all PIMs (p=0.02). PIM Categories (Figure 1) were compared and 65+y recipients received fewer days of benzodiazepines (log change -0.18, p=0.04) or narcotics (-0.21, p=0.04), but more days of anticholinergics (0.22, p=0.03) and GI PIMs (0.16, p 65+y group: In adjusted regression analysis, increasing days of narcotics was associated with a 1.6 fold (95% CI 1.1-2.6, p= 0.03) higher risk of NRM. Increasing days of narcotics was also associated with a 1.66 fold (95% CI 1.02-2.69) greater odds of grade 3-4 toxicities, p=0.04 (Figure 2). More days of all PIMs was associated with a 5 times greater odds of discharge to rehab or a nursing facility (95% CI 1.43-10.0, p Conclusions Older recipients (65+y) receive PIMs as frequently as younger recipients (40-64y). Females, those with a high HCT-CI and UCB recipients receive PIMs more frequently. Amongst older recipients, use of PIMs, particularly narcotics, was associated with a higher NRM and higher risks of grade 3-4 toxicities. Identifying and reducing use of PIMs in older HCT recipients may help lower the burden of adverse events and associated health care costs.