Frailty Assessment Can Be Incorporated into Routine Transplantation Practice

Frailty can adversely affect the outcomes of allogeneic hematopoietic cell transplantation (alloHCT), but this is difficult to measure in busy transplant clinics; however, a pilot study presented at the 2019 ASH Annual Meeting found that frailty and functionality can be assessed as part of routine clinical practice in alloHCT in all age groups.

The single-center, prospective, observational study included 96 consecutive patients (median age, 57 years; range, 20-74 years) referred for transplant. Patients underwent testing for frailty and function by clinician evaluation of clinical frailty scale (CFS). A nursing bone marrow transplant coordinator conducted an objective physical performance using the Timed up and Go (TUG) test and grip strength. Patients self-reported about their health and history of falls and underwent C-reactive protein (CRP) and albumin blood tests.

After a median follow-up of five months, the median overall survival (OS) at six months was 73.9% (range, 61.7-82.8%). Non-relapse mortality (NRM) at 100 days post-transplant was 8.7% (range, 2.6-14.7%). The cumulative incidence of acute graft-versus-host disease (GVHD) was 41.1% (range, 30.1-52.1%). Eight patients (8.3%) relapsed, and 23 (23.9%) died.

OS was diminished in patients with a TUG test score of more than 10 seconds and elevated CRP (P<0.05). Increased NRM was associated with abnormal TUG test scores, a self-rated health question score of <A, lower albumin levels, and increased CRP (P<0.05).

Predictors of longer median duration of transplant hospitalization included CFS of more than two, limitations of one or more instrumental activities of daily living, grip strength below normal for age and sex, TUG test score of greater than 10 seconds, self-rated health question <A, and lower albumin level.

Frailty or functionality parameters did not appear to be correlated with GVHD or the risk of rehospitalization after alloHCT.

“The TUG test is a useful prognostic tool [that] can be conducted in a clinic room and correlates with OS, NRM, and duration of hospitalization,” the authors concluded.

The study is limited by its small patient population and short duration of follow-up.

Reference

Salas MQ, Atenafu EG, Bascom O, et al. Pilot study on frailty and functionality on routine clinical assessment in allogeneic hematopoietic cell transplantation to predict outcomes. Abstract 380. Presented at the 2019 ASH Annual Meeting, December 8, 2019; Orlando, Florida.