Geriatric Assessment in Hematologic Therapies: A New Frontier in Personalizing Care for Older Adults

As hematopoietic stem cell transplant (HSCT) and cellular therapies extend their reach to older adults, the need for individualized treatment strategies has never been more urgent. Once considered too aggressive for aging patients, these therapies are now increasingly accessible due to evolving protocols and improved supportive care. But with age comes complexity—comorbidities, cognitive variability, and functional decline—which can dramatically alter treatment outcomes. That’s where comprehensive geriatric assessments (CGAs) are changing the game.

CGA is more than a checklist—it’s a multidimensional evaluation of a patient’s physical function, cognitive capacity, emotional well-being, comorbidities, and social support network. This holistic view provides crucial insight into a patient’s physiologic reserve and capacity to tolerate intensive interventions. And in the context of HSCT and cellular therapies, it’s becoming an indispensable tool for predicting treatment tolerance and complications.

Emerging evidence reinforces the predictive value of CGA in transplant medicine. Studies of older adults undergoing allogeneic HSCT consistently show that poor functional status, cognitive impairment, and markers of systemic inflammation correlate with increased risk of post-transplant complications and mortality. These findings are not just academic—they’re reshaping clinical pathways. For example, a patient with mild cognitive decline or frailty might still be a transplant candidate, but with tailored conditioning regimens, enhanced supportive care, and closer post-treatment monitoring.

Importantly, geriatric assessments uncover vulnerabilities that conventional tools often miss. A patient may have an acceptable performance status by ECOG or Karnofsky standards but still be at high risk for delirium, poor medication adherence, or functional decompensation. Incorporating CGA into pre-treatment evaluations enables oncologists and transplant teams to better stratify risk and individualize care—whether that means dose adjustment, additional caregiver support, or choosing alternative therapies altogether.

This approach is equally transformative in cellular therapies, such as CAR T-cell treatment, where toxicities like cytokine release syndrome and neurotoxicity pose significant risks. Here too, geriatric assessments help forecast not only physical resilience but cognitive vulnerabilities that could compound neurotoxic effects. Studies increasingly show that patients undergoing CGA-guided treatment planning experience fewer complications and better functional outcomes, even amid aggressive therapies.

Beyond predictive analytics, CGA also facilitates shared decision-making. Armed with a more complete understanding of their health status, patients and families can weigh the benefits and risks of intensive therapies more clearly. This aligns with the growing emphasis on patient-centered oncology, where treatment success is measured not only in survival metrics but in preserved independence, quality of life, and personal goals of care.

The clinical value of CGA is echoed in recent publications from Haematologica, JAMA Oncology, and others, which call for routine integration of geriatric principles into transplant and oncology practice. Meanwhile, guidelines from professional bodies such as the American Society of Clinical Oncology (ASCO) and the International Society of Geriatric Oncology (SIOG) are beginning to codify CGA as a standard component of care for older adults facing high-risk hematologic treatments.

What’s next? Implementation. Despite its promise, CGA remains underused in many transplant centers, often due to time constraints or lack of geriatric-trained staff. However, streamlined tools and multidisciplinary collaborations are making it more feasible. Some institutions have embedded geriatricians within oncology clinics or trained nurse practitioners to administer abbreviated CGAs efficiently. As these models evolve, the scalability of geriatric-informed oncology is becoming more achievable.

In a therapeutic landscape where intensity often collides with frailty, the integration of geriatric assessment offers a path forward—ensuring that advanced therapies don’t just extend life, but improve the experience of living it. For older adults considering HSCT or cellular therapy, this shift signals a more personalized, thoughtful approach—where age alone is no longer the limiting factor, but one of many pieces in a carefully constructed clinical picture.