Frailty is strongly associated with worse survival outcomes in patients with chronic graft-versus-host disease (GVHD), according to a recent analysis.
Nahid Rashid, MD, of the Fred Hutchinson Cancer Research Center and University of Washington in Seattle, and colleagues conducted the analysis and presented the results during the 64th American Society of Hematology Annual Meeting and Exposition.
Frailty after hematopoietic stem cell transplantation is associated with increased nonrelapse mortality (NRM) and decreased overall survival (OS), but it has not been “extensively studied” among patients who develop chronic GVHD, according to Dr. Rashid and colleagues.
They assessed the prevalence and predictors of frailty and its impact on transplant outcomes in 399 patients from 9 centers who were enrolled in the Chronic GVHD Consortium. They used Fried’s definition of frailty to evaluate patients, determining 32.3% of patients were frail and 67.7% were not frail.
Dr. Rashid and colleagues measured chronic GVHD variables at the time of patient enrollment, finding 29% had severe chronic GVHD, 54% had moderate chronic GVHD, and 17% had mild/less than mild chronic GVHD. The study included patients with newly diagnosed chronic GVHD and established GVHD. The median follow-up was 9.3 years.
Patients who were frail had a significantly lower 10-year OS rate (43%; 95% CI, 34-52) than patients who were not frail (63%; 95% CI, 57-69; P<.001), as well as a significantly higher 10-year NRM rate (41%; 95% CI, 32-49) than patients who were not frail (22%; 95% CI, 17-28; P<.001).
Frailty was significantly associated with higher chronic GVHD severity (P<.01). Thrombocytopenia (odds ratio [OR], 1.6; 95% CI, 0.9-2.9; P=.08), lung chronic GVHD (OR, 2.4; 95% CI, 1.5-4.0; P<.001), liver chronic GVHD (OR, 1.9; 95% CI, 1.1-3.3; P=.01), and older age (P=.003) were associated with frailty in a multivariable analysis that excluded chronic GVHD severity.
Chronic GVHD severity was significantly associated with NRM in a multivariable analysis (P=.006). However, chronic GVHD severity was not significantly associated with OS in a multivariable analysis. Frailty remained strongly associated with NRM and OS (P<.001).
Chronic GVHD severity and patient frailty did not have a significant interaction in the NRM or OS models. However, frailty, progressive-type onset of chronic GVHD, and having skin, lung, or liver involvement were associated with reduced OS in a multivariable analysis that excluded chronic GVHD severity and adjusted for older age and transplant center.
“Among patients who have [chronic] GVHD, frailty remains strongly associated with worse OS and higher NRM after adjusting for [chronic] GVHD severity or organ manifestations,” Dr. Rashid and colleagues concluded. “Patients older than 55 years and with lung or liver [chronic] GVHD are at higher risk of both being frail and for having worse transplant outcomes. Patients who develop [chronic] GVHD, especially in higher-risk groups, may benefit from clinical and rehabilitation interventions to alleviate frailty.”
Rashid N, Arora M, Carpenter PA, et al. The prevalence and effects of frailty in chronic graft-versus-host disease. Abstract #4719. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.