Resiliency in Older Adults Undergoing Bone Marrow Transplant

Primary outcomes

1. Change in Physical Performance as assessed by Short Physical Performance Battery (SPPB)

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

   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.

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

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

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

3. Change in upper extremity function as assessed by accelerometry

   Time frame: 7 consecutive days pre-BMT, at Day 30 and at Day 180

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

4. Change in catecholamines levels as assessed in overnight urine collection samples

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

   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 .

5. Change in Frailty as assessed by the Frailty Phenotype instrument

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

   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.

6. Change in Pittsburgh Fatigability Scale for Older Adults score

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

   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.

7. Change in Borg Rating of Perceived Exertion Scale score

   Time frame: Pre-BMT, Day 30 and Day 180 post transplant

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

8. Change in medical history and diseases/conditions self reporting

   Time frame: Pre-BMT and Day 180 post transplant

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

9. Change in health behaviors as assessed by a questionnaire

   Time frame: Pre-BMT and Day 180 post transplant

   This assessment is of self determined overall health as reported by a participant, it has no score.

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

    Time frame: Pre-BMT and Day 180 post transplant

    Questionnaire includes items on hospitalizations, surgeries, and falls. it has no score.

11. Change in pain reporting as assessed by the Pain Assessment Questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

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

12. Change in anxiety reporting as assessed by the anxiety questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

    Questions to assess the presence and severity of anxiety; higher scores = more anxiety.

13. Change in trauma reporting as assessed by the trauma questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

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

14. Change in cognitive function as assessed by Modified Mini-Mental State Examination

    Time frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant

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

15. Change in cognitive ability as assessed by the Montreal Cognitive Assessment

    Time frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant

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

16. Change in cognitive function as assessed by the Digit Symbol Substitution Test (DSST)

    Time frame: Pre-BMT, Day 30, Day 56 and Day 180 post transplant

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

17. Change in ability to cope with life challenges as assessed by the Coping Self-Efficacy Scale

    Time frame: Pre-BMT and Day 180 post transplant

    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.

18. Change in sense of well-being as assessed by the Subscale of Ryff Psychological Well-being Scale

    Time frame: Pre-BMT and Day 180 post transplant

    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.

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

    Time frame: Pre-BMT and Day 180 post transplant

    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.

20. Change in personality as measured by the Ten Item Personality Inventory (TIPI) Scale

    Time frame: Pre-BMT and Day 180 post transplant

    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)

21. Change in optimism as assessed by the Life Orientation Scale-Revised

    Time frame: Pre-BMT and Day 180 post transplant

    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.

22. Change in perceived loneliness as assessed by the Loneliness Scale

    Time frame: Pre-BMT and Day 180 post transplant

    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

23. Change in perceived socio-economic status as assessed by the US socioeconomic questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

    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".

24. Change in perceived financial strain as assessed by Financial Strain questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

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

25. Change in feeling of community inclusion as assessed by the Social Cohesion Questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

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

26. Change in feeling of isolation as assessed by the Social Isolation/Engagement Questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

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

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

    Time frame: Pre-BMT and Day 180 post transplant

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

28. Change in feelings of depression as assessed by the Patient Health Questionnaire

    Time frame: Pre-BMT and Day 180 post transplant

    Measures depressive symptoms in the last 2 weeks (PHQ-8)

29. Change in perceived childhood trauma as assessed by the Adverse Childhood Events (ACE) Scale

    Time frame: Pre-BMT and Day 180 post transplant

    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."

30. Changes in perceived stress as assessed by the Perceived Stress Scale

    Time frame: Pre-BMT and Day 180 post transplant

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

31. Change in bone marrow cell ratios as assessed by Bone Marrow Aspirate

    Time frame: pre-transplant and at Day 180 post-transplant

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

32. Change in hemoglobin tests.

    Time frame: pre-transplant and then at Day 30, Day 56 and Day 180 post-transplant

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

33. changes in salivary plasma free cortisol collection

    Time frame: single 24 hour period before BMT and at Day 180 post-transplant

    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.

34. Change in cortisol level

    Time frame: pre-transplant and at Day 180 post-transplant

    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).

35. Changes in interleukin (IL)-6 level

    Time frame: pre-transplant and at Day 180 post-transplant

    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).

36. Change in dehydroepiandrosterone (DHEA) level

    Time frame: pre-transplant and at Day 180 post-transplant

    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).

37. Change in glucose tolerance as assessed by the Oral Glucose Tolerance Test (OGTT)

    Time frame: pre-transplant and at Day 180 post-transplant

    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

38. Change in heart rate variability as assessed by the "myPatch" Holter monitor

    Time frame: During clinic visits at pre-transplant, Day 30, Day 56 and Day 180

    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.

39. Change in attention as assessed by the Flanker Inhibitory Control and Attention Test score

    Time frame: pre-transplant, once a week from Day of transplant to Day 60 and at Day 180 post-transplant

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