Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 56; no. 1; pp. 60 - 69
• Main Authors: Salas, Maria Queralt, Atenafu, Eshetu G., Bascom, Ora, Wilson, Leeann, Lam, Wilson, Law, Arjun Datt, Pasic, Ivan, Kim, Dennis (Dong Hwan), Michelis, Fotios V., Al-Shaibani, Zeyad, Gerbitz, Armin, Viswabandya, Auro, Lipton, Jeffrey Howard, Mattsson, Jonas, Alibhai, Shabbir M. H., Kumar, Rajat
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2021; Nature Publishing Group
• Subjects: 692/499; 692/700/784; Activities of daily living; Albumins; C-reactive protein; Cell Biology; Evaluation; Frailty; Grip strength; Hematology; Hematopoietic stem cells; Internal Medicine; Medicine; Medicine & Public Health; Public Health; Questions; Risk analysis; Risk factors; Stem cell transplantation; Stem Cells; Transplantation; Canada
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-020-0979-1

A Frailty and Functionality evaluation for alloHCT was implemented using existing resources. We describe the implementation of this evaluation across all ages and at first consultation, and correlate results with posttransplant outcomes in 168 patients. The evaluation consists of: Clinical Frailty Scale (CFS), Instrumental Activities of Daily Living (IADL), grip strength (GS), timed up and go test (TUGT), self-rated health question (SRH), Single question of Falls, albumin and C-Reactive Protein (CRP) levels. Median time to perform the evaluation was 5–6 min. Median age was 58 years (range: 19–77) and median follow-up was 5.3 months. TUGT > 10 s (HR 2.92; p  = 0.003), raised CRP (HR 4.40; p  < 0.001), and hypoalbuminemia (HR 2.10; p  = 0.043) were significant risk factors for worse overal survival (OS). CFS ≥ 3 (HR 3.11; p  = 0.009), TUGT > 10 s (HR 3.47; p  = 0.003), GS (HR 2.56; p  = 0.029), SRH (<excellent) (HR 3.8 × 10 6 ; p  < 0.001), elevated CRP (HR 11.8; p  < 0.001), and hypoalbuminemia (HR 4.6; p  < 0.001), were significant predictors for worse non relapse mortality (NRM). On multivariable analysis, TUGT > 10 s and raised CRP were significant predictors for worse OS and NRM. SRH (<excellent) was a significant predictor for higher NRM. Frailty and Functionality can be assessed in routine clinical practice in alloHCT and may be predictive of short-term outcomes.