Resiliency in Older Adults Undergoing Bone Marrow Transplant (REBOUND)

REBOUND: REsiliency in Older Adults UNDergoing BOne Marrow Transplant - A Pilot Study of Resiliency Measures in Older Patients Undergoing Allogeneic Blood and Marrow Transplant

The objective of this research is to measure certain indicators of resiliency to better understand which participants who are over 60 years old will respond more positively to bone marrow transplant. This research is being done to determine if there are traits that make recipients more likely to bounce back following allogeneic bone marrow transplant (BMT).

Allogeneic blood and marrow transplantation (alloBMT) is the only potentially curative therapy for many forms of leukemia, lymphoma, and other hematologic malignancies. As with many forms of cancer, many of the most common indications for alloBMT disproportionally affect older people. Although treatments have improved for older adults undergoing therapies for these diseases, the outcomes are variable and there is little biological knowledge to help identify specific factors that would predict why some people do well with treatment and others develop functional and cognitive decline and other adverse health outcomes. Data specific to patients older than 60 who have undergone alloBMT are sparse even though the 1 year non-relapse mortality rate in patients older than age 50 at Johns Hopkins is 12%. In none of these studies have geriatric assessment measures in domains such as cognition and function been evaluated. Given the low incidence of non-relapse mortality in the investigators' older patients, the investigators have a unique opportunity to study the factors that influence not only mortality but function after hematopoietic stem cell transplantation. The investigators aim to be able to counsel patients more specifically about likely outcomes after transplant.

Leukemia, Lymphoma, Blood Cancer, Myelodysplastic Syndrome, Acute Myelogenous Leukemia, Non-Hodgkins Lymphoma

Age ≥60 years who are undergoing allogeneic bone marrow transplant at Johns Hopkins Hospital to treat a hematologic malignancy

Study visits will include the performance of assessments prior to the start of conditioning chemotherapy and at 1 month and 6 months post-BMT. Assessments include: Physical function assessments questionnaires about general health and current health compared to health one year ago assessments that measure cognition, attention and memory assessments regarding personality and psychological and social stressors Physiological measures including blood tests- 160 mL of blood during evaluations, and 90mL of blood at the day 180 visit. bone marrow aspirate collected during standard of care bone marrow biopsies pre-transplant and at day 180 Saliva collections pre-transplant ACTH Stimulation Test Oral Glucose Tolerance Test Holter Monitor- to record hear rate variability MRI pre-transplant and at Day 180 in a subset of 10 subjects

Bone marrow transplantation will be conducted according to the investigators' institution's standard of care, or else according to research protocol (if applicable).Study visits that include the performance of assessments will occur prior to the start of conditioning chemotherapy and at 1 month and 6 months post-BMT. All dates are +/- 7 days. The initial study visit will take place during standard of care pre-transplant evaluations, which typically span 3-4 days. The post-BMT visits will take place before or after regularly-scheduled BMT follow up.

5 measured criteria: unintentional weight loss, exhaustion, low energy expenditure, low grip strength, and slowed waking speed. Scores of 3, 4 and 5 are consistent with frailty, scores of 1 and 2 are consistent with pre-frailty status, and a score of 0 is consistent with a robust or resilient status.

Change in ability to perform activities of daily living as assessed by Instrumental Activities of Daily Living questionnaire

questions about ability to perform activities of daily living (IADL). Scored low functioning (0) to high functioning (8).

device worn on wrist for a 24hr period that measures physical activity and sedentary activity. Higher scores= more active.

Changes in catecholamines level will be assessed in overnight urine collection samples. Levels fluctuate. Analysis will use the Johns Hopkins University (JHU) normal reference range for an adult is Metanephrine (normotensive):45-290 μg/24 hours. Metanephrine (hypertensive): 35-460 μg/24 hours .

Frailty Phenotype instrument is used to measure participants' walking speed and grip strength, includes questions about exhaustion, physical activity, weight loss. Higher scores indicate better functional state.

self-report tool that normalizes activities in terms of intensity and duration (PFS) this has a range of 0-50 with higher scores indicating greater physical fatigability.

scale will be used immediately after a slow-paced 5-minute treadmill walk to assess fatigability (RPE). Higher score indicates higher perceived exertion.

Questionnaire of past medical history as reported by a subject. This questionnaire does not have a score.

Change in reporting of patients traumas as assessed by the Hospitalizations, Surgeries, and Falls Questionnaire

questions on overall bodily pain intensity/frequency and pain-related function/interference. Higher scores equal more pain.

Questions to assess a participants reporting of any past experiences of several kinds of trauma. It has no score.

measure of global cognitive function (range 0-100). A score of 100 represents total cognitive function according to 3MS.

measures global cognitive function (MoCA). Scores range between 0 and 30. A score of 26 or over is considered to be normal.

participant fill in a series of symbols correctly coded within 90 seconds. The higher the score, the better the participant's performance.

11-point Likert scale measures perceived ability to cope effectively with life. Scale is 0-10 with 10 = best ability to cope and 0 = no ability to cope.

7-item Likert type scale (from strongly disagree to strongly agree) measures sense of direction and perception of purpose. Scale is 0-7 with 7 = best sense of well-being and 0 = no sense of well-being.

Change in perception and satisfaction with life as assessed by the Meaning in Life Questionnaire and Scale

Likert-type scale measuring perception of meaning and satisfaction with life (MLQ) Scale is 0-7 with 7 = best sense that life has meaning and 0 = no sense that life has meaning.

7 point Likert-type scale of disagree to agree with various aspects of personality measuring: extraversion, agreeableness, neuroticism, openness, conscientiousness. TIPI scale scoring. Extraversion: 1, 6R; Agreeableness: 2R, 7; Conscientiousness; 3, 8R; Emotional Stability: 4R, 9; Openness to Experiences: 5, 10R. ("R" denotes reverse-scored items)

5 point Likert scale, assessing optimism. 0= strongly disagree; 4 = strongly agree. The total score is from 0 to 24; higher scores indicate more optimism.

Revised University of California, Los Angeles (UCLA) Loneliness Scale. Each question is rated on a 4-point scale: 1 = never; 2 = Rarely; 3 = Sometimes 4 = Always. All items are summed to give a total score. Higher scores indicate more loneliness

10-rung ladder to assess a participant's perception of participant's status in society. To score this measure, researchers simply note the number of the rung (1-10) on which the respondent placed their "X".

2 item measure evaluating difficulty and anxiety about money. Higher scores equal higher financial strain.

Participants rate their community by rate of agreement. Response is Agree a lot, a little, do not agree with 3 statements about their community.

7-item measure evaluating social isolation, participation and engagement with others. Higher scores= greater sense of isolation.

Change in perceived confidence in spirituality as assessed by the Religion/Spirituality Questionnaire

5-Item measure for use in epidemiological studies regarding spirituality. Score range from 5-27, with higher scores = more sense of spirituality

10-item measure to assess childhood abuse and household dysfunction. Response is yes/no. The ACE Scale is scored by summing the number of items for which respondents answered "yes."

5-point Likert scale measures the cognitive appraisal and perceptions of stress in life. Higher score= high level of perceived stress.

aspirate will be collected during standard of care bone marrow biopsies and analyzed using JHU normal reference ranges.

160 mL of blood during evaluations, and 90mL of blood at the day 180 visit. Assessment will be documents using Hopkins normal reference ranges

Saliva collected at home by participants at 4 time points during a single 24 hour period. The mean salivary cortisol concentration is 15.5 +/- 0.8 nmol/L (range, 10.2-27.3) at 0800 h and 3.9 +/- 0.2 nmol/L (range, 2.2-4.1) at 2000 h.

This is part of the ACTH Stimulation test to assess the reactivity of hypothalamic-pituitary-adrenal (HPA) axis. Test After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for cortisol levels (mcg/dL).

This is part of the ACTH Stimulation test to assess the reactivity of HPA axis. After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for IL-6 levels (pg/ml).

This is part of the ACTH Stimulation test to assess the reactivity of HPA axis. After the baseline blood draw is taken, 1mcg (low dose) Cosyntropin (synthetic ACTH) will be given intravenously by a research nursing staff followed by serial blood sampling to test for DHEA levels (µg/dL).

Participants will fast overnight and then be given the 75 gram glucose oral load followed by blood draws at 0, 30. 60 and 120 minutes. At 120min, below 140mg/dL= normal blood sugar. 200mg/dL or higher= diabetes

lightweight digital device that records and stores electrocardiogram (ECG) data on a continuous basis during study visits. A normal resting heart rate for adults ranges from 60 to 100 beats per minute. Generally, a lower heart rate at rest implies more efficient heart function.

Measures attention and inhibitory control. Scoring is 0-10. Details and interpretations are available in the NIH toolbox scoring and interpretation guide.

Inclusion Criteria: Undergoing allogeneic bone marrow transplant at Johns Hopkins Hospital, the indication for which is a hematologic malignancy Age ≥60 years Ability to walk without human assistance Enrollment in concomitant clinical research is permitted but not required English-speaking Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Unwillingness or inability to return at 6 months after transplantation for repeated evaluation Non-English-speaking