(219) SIPAT and allogeneic hematopoietic transplant outcomes: Early Data

Presenting Author(s)

AM

Adrienne D. Mishkin, MD,MPH,MS,FACLP,DFAPA (She)

Associate Professor
Columbia University Medical Campus
New York, New York

Co-Author(s)

Peter A. Shapiro, MD (he/him/his)

Professor of Psychiatry, Director of CL Psychiatry
Columbia Univesity Medical Center
New York, New York
MM

Markus Mapara, MD, PhD

Professor of Medicine, Director of the Blood and Marrow Transplantation Program
Columbia University Medical Center
New York, New York
RR

Ran Reshef, MD

Professor of Medicine
Columbia University Irving Medical Center
New York, New York
KS

Kathleen Silfer, MPAS, PA-C

Physician Assistant
NYP
New York, New York
TR

Tyler Ruemmele, MPAS

Physician Assistant
.
New York, New York

Disclosure(s):

Adrienne D. Mishkin, MD,MPH,MS,FACLP,DFAPA: No financial relationships to disclose

Abstract: Hematopoietic stem cell transplantation (HSCT), the only cure for several malignant and non-malignant hematopoietic disorders, imposes high demands on patients, requiring frequent visits, tests, and medication adjustments, diet modification, physical therapy, and readmissions. The paucity of research on predictors of poor adherence, on the relationships between non-adherence, morbidity, and mortality, and on ways to support adherence represents a critical gap in knowledge of modifiable factors contributing to long-term post-HSCT survival. ). In a retrospective pilot study including 85 autologous and allogeneic SCT patients, we found SIPAT rating to predict non-adherence (OR 1.162, p< 0.0001)[1] delirium (OR 1.090, p = 0.021), ICU admissions (OR 1.09, p=0.021), and length of stay (p=0.034), with a SIPAT of 18 as the best cutoff to maximize specificity and sensitivity for higher risk. Our ongoing study with recruitment goal of 150 cancer patients who receive allogeneic HSCT at our center has longterm goals 1: To determine the association of psychosocial risk factors, identified prior to HSCT, with treatment adherence after HSCT: Our primary hypothesis is that psychosocial factors, as indexed by the SIPAT score, are associated with subsequent non-adherence. By measuring 4 domains of psychosocial risk and 21 categories of non-adherence, we aim to correlate types of risks with specific types of non-adherence, allowing for future targeted interventions to be studied. 2: To determine the association of psychosocial risk factors with morbidity and mortality after HSCT, and examine the mediating effect of non-adherence on these outcomes. Our secondary hypothesis is that psychosocial risk as indexed by 4 SIPAT domains and the total SIPAT score is associated with morbidity and mortality. Exploratory

Aims: We will also explore relationships between psychosocial factors and incident delirium, graft-vs-host disease (GVHD), and hospital readmission, and between specific adherence domains, morbidity, and mortality. At this time we are presenting evolving data from open enrollment in 2018 through 4/1/2024, which includes 38 subjects who have consented to this study and completed 1 year of observation after allo-HSCT. Of these patients, 8 died in the first year after transplant, and 6 had non-adherence reports of any kind. Our preliminary interim analysis findings includes that SIPAT of 18 or higher trended towards predicting nonadherence but was not significant at p = 0.589032, and SIPAT of 18 or higher significantly predicted 1-year mortality whether including (p= .00951) or excluding (p=.018638) the 4 patients with non-oncological diagnoses. Our ongoing and future work will (1) continue to recruit to our goal of 150 patients with oncological diagnoses (2) further refine by type of non-adherence/severity of potential impact (3) consider additional medical outcomes such as transplant-related mortality versus relapse, GVHD, ICU admissions, LOS (4) Correct for age, gender, and specific diagnosis.

Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This subject pool is diverse and is not recruiting for or against any immutable traits.
One of our subject subgroups is patients with SCD and if we ultimately have sufficient SCD patients we will perform a separate analysis to look for findings unique to this population subject to intersectional marginalization.
Race, gender, and ethnic background will be controlled for and considered in later analyses when the population is large enough for those statistics to be meaningful.