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Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Bone Marrow Transplantation volume 53, pages 3–10 (2018)Cite this article

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Abstract

Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.

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References

  1. D'Souza A, Zhu X Current Uses and Outcomes of Hematopoietic Cell Transplantation (HCT): CIBMTR Summary Slides, 2016. Available at: http://www.cibmtr.org.

  2. McClune BL, Weisdorf DJ, Pedersen TL, Tunes d a Silva G, Tallman MS, Sierra J et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol 2010; 28: 1878–1887.

    PubMed  PubMed Central  Google Scholar 

  3. Storb R . Can reduced-intensity allogeneic transplantation cure older adults with AML? Best Pract Res Clin Haematol 2007; 20: 85–90.

    PubMed  Google Scholar 

  4. Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010; 363: 2091–2101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Brunner AM, Kim HT, Coughlin E, Alyea EP, Armand P, Ballen KK et al. Outcomes in patients age 70 or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Biol Blood Marrow Transplant 2013; 19: 1374–1380.

    PubMed  Google Scholar 

  6. Rashidi A, Ebadi M, Colditz GA, DiPersio JF . Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia: a systematic review and meta-analysis. Biol Blood Marrow Transplant 2016; 22: 651–657.

    PubMed  Google Scholar 

  7. Shimoni A, Labopin M, Savani B, Volin L, Ehninger G, Kuball J et al. Long-term survival and late events after allogeneic stem cell transplantation from HLA-matched siblings for acute myeloid leukemia with myeloablative compared to reduced-intensity conditioning: a report on behalf of the acute leukemia working party of Eur. J Hematol Oncol 2016; 9: 118.

    PubMed  PubMed Central  Google Scholar 

  8. Koreth J, Aldridge J, Kim HT, Alyea EP, Cutler C, Armand P et al. Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. Biol Blood Marrow Transplant 2010; 16: 792–800.

    PubMed  PubMed Central  Google Scholar 

  9. Pidala J, Craig BM, Lee SJ, Majhail N, Quinn G, Anasetti C . Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2013; 48: 63–67.

    CAS  PubMed  Google Scholar 

  10. Hamaker ME, Stauder R, van Munster BC . Exclusion of older patients from ongoing clinical trials for hematological malignancies: an evaluation of the National Institutes of Health Clinical Trial Registry. Oncologist 2014; 19: 1069–1075.

    PubMed  PubMed Central  Google Scholar 

  11. Townsley CA, Selby R, Siu LL . Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 2005; 23: 3112–3124.

    PubMed  Google Scholar 

  12. Sorror ML, Sandmaier BM, Storer BE, Franke GN, Laport GG, Chauncey TR et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA 2011; 306: 1874–1883.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Lazarevic V, Hörstedt A-S, Johansson B, Antunovic P, Billström R, Derolf A et al. Incidence and prognostic significance of karyotypic subgroups in older patients with acute myeloid leukemia: the Swedish population-based experience. Blood Cancer J 2014; 4: e188.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE et al. Age and acute myeloid leukemia. Blood 2006; 107: 3481–3485.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–397.

    PubMed  PubMed Central  Google Scholar 

  16. Ness KK, Krull KR, Jones KE, Mulrooney DA, Armstrong GT, Green DM et al. Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: a report from the St Jude Lifetime cohort study. J Clin Oncol 2013; 31: 4496–4503.

    PubMed  PubMed Central  Google Scholar 

  17. Arora M, Sun C, Ness K, Teh JB, Schad A, Hanby C et al. Older survivors of allogeneic hematopoietic cell transplantation (HCT) with chronic graft vs. host disease (cGvHD) demonstrate higher risk of frailty as compared with autologous HCT recipients: a report from the Bone Marrow Transplant Survivor Study-2. Biol Blood Marrow Transplant 2015; 21: S72–S73.

    Google Scholar 

  18. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC . Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60: 1487–1492.

    PubMed  Google Scholar 

  19. Artz A, Swanson K, Kocherginsky M, Godley L, Kline J, Nguyen V et al. Features of frailty are surprisingly common in adults 50 years and older undergoing allogeneic hematopoietic cell transplantation (HCT) in the modern era. Biol Blood Marrow Transplant 2011; 17: S302.

    Google Scholar 

  20. Muffly LS, Kocherginsky M, Stock W, Chu Q, Bishop MR, Godley LA et al. Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients. Haematologica 2014; 99: 1373–1379.

    PubMed  PubMed Central  Google Scholar 

  21. Arora M, Bhatia S, DeFor TE, Nayar M, Belete H, Lund T et al. Impact of frailty on hematopoietic cell on early transplant outcomes in older recipients. Blood 2015; 126: 388.

    Google Scholar 

  22. Arora M, Sun C-L, Ness KK, Teh JB, Wu J, Francisco L et al. Physiologic frailty in nonelderly hematopoietic cell transplantation patients. JAMA Oncol 2016; 2: 1277.

    PubMed  PubMed Central  Google Scholar 

  23. Wood WA, Krishnamurthy J, Mitin N, Torrice C, Parker JS, Snavely AC et al. Chemotherapy and stem cell transplantation increase p16INK4a expression, a biomarker of T-cell aging. EBioMedicine 2016; 11: 227–238.

    PubMed  PubMed Central  Google Scholar 

  24. Alfano CM, Peng J, Andridge RR, Lindgren ME, Povoski SP, Lipari AM et al. Inflammatory cytokines and comorbidity development in breast cancer survivors versus noncancer controls: evidence for accelerated aging? J Clin Oncol 2017; 35: 149–156.

    PubMed  Google Scholar 

  25. Childs BG, Durik M, Baker DJ, van Deursen JM . Cellular senescence in aging and age-related disease: from mechanisms to therapy. Nat Med 2015; 21: 1424–1435.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Gupta V, Panzarella T, Li L, Khan J, Sharma A, Lipton JH et al. A prospective study comparing the outcomes and health-related quality of life in adult patients with myeloid malignancies undergoing allogeneic transplantation using myeloablative or reduced-intensity conditioning. Biol Blood Marrow Transplant 2012; 18: 113–124.

    PubMed  Google Scholar 

  27. Pallua S, Giesinger J, Oberguggenberger A, Kemmler G, Nachbaur D, Clausen J et al. Impact of GvHD on quality of life in long-term survivors of haematopoietic transplantation. Bone Marrow Transplant 2010; 45: 1534–1539.

    CAS  PubMed  Google Scholar 

  28. Pidala J, Kurland B, Chai X, Majhail N, Weisdorf DJ, Pavletic S et al. Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: report on baseline data from the Chronic GVHD Consortium. Blood 2011; 117: 4651–4657.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Kurosawa S, Oshima K, Yamaguchi T, Yanagisawa A, Fukuda T, Kanamori H et al. Patient-reported quality of life after allogeneic hematopoietic cell transplantation according to types and severity of chronic Gvhd. Blood 2016; 128: 1240.

    Google Scholar 

  30. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Sorror ML, Logan BR, Zhu X, Rizzo JD, Cooke KR, McCarthy PL et al. Prospective validation of the predictive power of the Hematopoietic Cell Transplantation Comorbidity Index: a Center for International Blood and Marrow Transplant Research Study. Biol Blood Marrow Transplant 2015; 21: 1479–1487.

    PubMed  PubMed Central  Google Scholar 

  32. Sorror ML, Storer BE, Sandmaier BM, Maris M, Shizuru J, Maziarz R et al. Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol 2008; 26: 4912–4920.

    PubMed  PubMed Central  Google Scholar 

  33. Sorror ML, Storb RF, Sandmaier BM, Maziarz RT, Pulsipher MA, Maris MB et al. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol 2014; 32: 3249–3256.

    PubMed  PubMed Central  Google Scholar 

  34. Sorror M, Storer B, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al. Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008; 112: 1992–2001.

    PubMed  Google Scholar 

  35. Artz AS, Pollyea DA, Kocherginsky M, Stock W, Rich E, Odenike O et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12: 954–964.

    PubMed  Google Scholar 

  36. Sorensen JB, Klee M, Palshof T, Hansen HH . Performance status assessment in cancer patients. An inter-observer variability study. Br J Cancer 1993; 67: 773–775.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Chow R, Chiu N, Bruera E, Krishnan M, Chiu L, Lam H et al. Inter-rater reliability in performance status assessment among health care professionals: a systematic review. Ann Palliat Med 2016; 5: 83–92.

    PubMed  Google Scholar 

  38. Kim YJ, Hui D, Zhang Y, Park JC, Chisholm G, Williams J et al. Differences in performance status assessment among palliative care specialists, nurses, and medical oncologists. J Pain Symptom Manage 2015; 49: 1050–1058.e2.

    PubMed  Google Scholar 

  39. de Borja M-T, Chow E, Bovett G, Davis L, Gillies C . The correlation among patients and health care professionals in assessing functional status using the Karnofsky and Eastern Cooperative Oncology Group Performance Status Scales. Support Cancer Ther 2004; 2: 59–63.

    PubMed  Google Scholar 

  40. Blagden SP, Charman SC, Sharples LD, Magee LRA, Gilligan D . Performance status score: do patients and their oncologists agree? Br J Cancer 2003; 89: 1022–1027.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Atkinson TM, Andreotti CF, Roberts KE, Saracino RM, Hernandez M, Basch E . The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review. Support Care Cancer 2015; 23: 3645–3652.

    PubMed  PubMed Central  Google Scholar 

  42. Schnadig ID, Fromme EK, Loprinzi CL, Sloan JA, Mori M, Li H et al. Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. Cancer 2008; 113: 2205–2214.

    PubMed  Google Scholar 

  43. Liu MA, Hshieh T, Condron N, Wadleigh M, Abel GA, Driver JA . Relationship between physician and patient assessment of performance status and survival in a large cohort of patients with haematologic malignancies. Br J Cancer 2016; 115: 858–861.

    PubMed  PubMed Central  Google Scholar 

  44. Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP et al. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood 2012; 120: 905–913.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME et al. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood 2014; 123: 3664–3671.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Jones DM, Song X, Rockwood K . Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 2004; 52: 1929–1933.

    PubMed  Google Scholar 

  47. Mitnitski A, Song X, Skoog I, Broe G, Cox JL, Grunfeld E et al. Relative fitness and frailty of elderly men and women in developed countries and their relationship with mortality. J Am Geriatr Soc 2005; 53: 2184–2189.

    PubMed  Google Scholar 

  48. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I . Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 2006; 54: 975–979.

    PubMed  Google Scholar 

  49. Extermann M, Hurria A . Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 2007; 25: 1824–1831.

    PubMed  Google Scholar 

  50. Tucci A, Ferrari S, Bottelli C, Borlenghi E, Drera M, Rossi G . A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer 2009; 115: 4547–4553.

    PubMed  Google Scholar 

  51. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.

    CAS  PubMed  Google Scholar 

  52. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G . Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59: 255–263.

    PubMed  Google Scholar 

  53. Rothman MD, Leo-Summers L, Gill TM . Prognostic significance of potential frailty criteria. J Am Geriatr Soc 2008; 56: 2211–2216.

    PubMed  PubMed Central  Google Scholar 

  54. Mitnitski AB, Mogilner AJ, Rockwood K . Accumulation of deficits as a proxy measure of aging. Sci World J 2001; 1: 323–336.

    CAS  Google Scholar 

  55. Mitnitski AB, Graham JE, Mogilner AJ, Rockwood K . Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 2002; 2: 1.

    PubMed  PubMed Central  Google Scholar 

  56. Freyer G, Geay J-F, Touzet S, Provencal J, Weber B, Jacquin J-P et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol Off J Eur Soc Med Oncol 2005; 16: 1795–1800.

    CAS  Google Scholar 

  57. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz J-P, Lichtman S et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 2005; 55: 241–252.

    PubMed  Google Scholar 

  58. Muffly LS, Boulukos M, Swanson K, Kocherginsky M, Cerro P, del, Schroeder L et al. Pilot study of comprehensive geriatric assessment (CGA) in allogeneic transplant: CGA captures a high prevalence of vulnerabilities in older transplant recipients. Biol Blood Marrow Transplant 2013; 19: 429–434.

    PubMed  Google Scholar 

  59. Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 2016; 45: 353–360.

    PubMed  PubMed Central  Google Scholar 

  60. Hamaker ME, Jonker JM, de Rooij SE, Vos AG, Smorenburg CH, van Munster BC . Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol 2012; 13: e437–e444.

    PubMed  Google Scholar 

  61. Pijpers E, Ferreira I, Stehouwer CDA, Nieuwenhuijzen Kruseman AC . The frailty dilemma. Review of the predictive accuracy of major frailty scores. Eur J Intern Med 2012; 23: 118–123.

    PubMed  Google Scholar 

  62. Artz AS, Logan BR, Zhu X, Akpek G, Martino R, Gupta V et al. Pre-transplant C-reactive protein (CRP), ferritin and albumin as biomarkers to predict transplant related mortality (trm) after allogeneic hematopoietic cell transplant (HCT). Blood 2014; 124: 422.

    Google Scholar 

  63. Roubenoff R, Parise H, Payette HA, Abad LW, D’Agostino R, Jacques PF et al. Cytokines, insulin-like growth factor 1, sarcopenia, and mortality in very old community-dwelling men and women: the Framingham Heart Study. Am J Med 2003; 115: 429–435.

    CAS  PubMed  Google Scholar 

  64. Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH et al. Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med 1999; 106: 506–512.

    CAS  PubMed  Google Scholar 

  65. Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DSJ et al. A comparison of inflammation-based prognostic scores in patients with cancer. A Glasgow Inflammation Outcome Study. Eur J Cancer 2011; 47: 2633–2641.

    PubMed  Google Scholar 

  66. Rosko A, Hofmeister C, Benson D, Efebera Y, Huang Y, Gillahan J et al. Autologous hematopoietic stem cell transplant induces the molecular aging of T-cells in multiple myeloma. Bone Marrow Transplant 2015; 50: 1379–1381.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Gadalla SM, Wang T, Loftus D, Friedman L, Dagnall C, Haagenson MD et al. Donor telomere length and outcomes after allogeneic unrelated hematopoietic cell transplant in patients with acute leukemia. Blood 2016; 128: 520.

    Google Scholar 

  68. Gadalla SM, Wang T, Dagnall C, Haagenson M, Spellman SR, Hicks B et al. Effect of recipient age and stem cell source on the association between donor telomere length and survival after allogeneic unrelated hematopoietic cell transplantation for severe aplastic anemia. Biol Blood Marrow Transplant 2016; 22: 2276–2282.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Jacobsen PB, Le-Rademacher J, Jim H, Syrjala K, Wingard JR, Logan B et al. Exercise and stress management training prior to hematopoietic cell transplantation: Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0902. Biol Blood Marrow Transplant 2014; 20: 1530–1536.

    PubMed  PubMed Central  Google Scholar 

  70. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman-Hill R, Horwood J et al. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis. Lancet (London, England) 2008; 371: 725–735.

    Google Scholar 

  71. Cadore EL, Rodríguez-Mañas L, Sinclair A, Izquierdo M . Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res 2013; 16: 105–114.

    PubMed  PubMed Central  Google Scholar 

  72. Theou O, Stathokostas L, Roland KP, Jakobi JM, Patterson C, Vandervoort AA et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J Aging Res 2011; 2011: 569194.

    PubMed  PubMed Central  Google Scholar 

  73. Wiskemann J, Dreger P, Schwerdtfeger R, Bondong A, Huber G, Kleindienst N et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117: 2604–2613.

    CAS  PubMed  Google Scholar 

  74. Oswald WD, Gunzelmann T, Rupprecht R, Hagen B . Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective. Eur J Ageing 2006; 3: 179–192.

    PubMed  PubMed Central  Google Scholar 

  75. Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MDL, Adams JE, Oldham JA et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab 2010; 95: 639–650.

    CAS  PubMed  Google Scholar 

  76. Borst SE, Millard WJ, Lowenthal DT . Growth hormone, exercise, and aging: the future of therapy for the frail elderly. J Am Geriatr Soc 1994; 42: 528–535.

    CAS  PubMed  Google Scholar 

  77. Muir SW, Montero-Odasso M . Effect of Vitamin D supplementation on muscle strength, gait and balance in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2011; 59: 2291–2300.

    PubMed  Google Scholar 

  78. Fiatarone MA, O’Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 1769–1775.

    CAS  PubMed  Google Scholar 

  79. Loprinzi CL, Ellison NM, Schaid DJ, Krook JE, Athmann LM, Dose AM et al. Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. J Natl Cancer Inst 1990; 82: 1127–1132.

    CAS  PubMed  Google Scholar 

  80. Yeh S-S, Wu S-Y, Lee T-P, Olson JS, Stevens MR, Dixon T et al. Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study. J Am Geriatr Soc 2000; 48: 485–492.

    CAS  PubMed  Google Scholar 

  81. Sullivan DH, Roberson PK, Smith ES, Price JA, Bopp MM . Effects of muscle strength training and megestrol acetate on strength, muscle mass, and function in frail older people. J Am Geriatr Soc 2007; 55: 20–28.

    PubMed  Google Scholar 

  82. Jatoi A, Windschitl HE, Loprinzi CL, Sloan JA, Dakhil SR, Mailliard JA et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol 2002; 20: 567–573.

    CAS  PubMed  Google Scholar 

  83. Kardinal CG, Loprinzi CL, Schaid DJ, Hass AC, Dose AM, Athmann LM et al. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 1990; 65: 2657–2662.

    CAS  PubMed  Google Scholar 

  84. Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ . Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer’s disease. Int J Geriatr Psychiatry 1997; 12: 913–919.

    CAS  PubMed  Google Scholar 

  85. Khatcheressian J, Cassel JB, Lyckholm L, Coyne P, Hagenmueller A, Smith TJ . Improving palliative and supportive care in cancer patients. Oncology (Williston Park) 2005; 19: 1365–1376; discussion 1377–8, 1381–2, 1384 passim.

    Google Scholar 

  86. Elsayem A, Swint K, Fisch MJ, Palmer JL, Reddy S, Walker P et al. Palliative care inpatient service in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol 2004; 22: 2008–2014.

    PubMed  Google Scholar 

  87. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 2014; 383: 1721–1730.

    PubMed  Google Scholar 

  88. Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 2015; 33: 1438–1445.

    PubMed  PubMed Central  Google Scholar 

  89. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363: 733–742.

    CAS  PubMed  Google Scholar 

  90. El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer JA, Pirl WF et al. Effect of inpatient palliative care on quality of life 2 weeks after hematopoietic stem cell transplantation. JAMA 2016; 316: 2094.

    PubMed  PubMed Central  Google Scholar 

  91. Loggers ET, LeBlanc TW, El-Jawahri A, Fihn J, Bumpus M, David J et al. Pretransplantation supportive and palliative care consultation for high-risk hematopoietic cell transplantation patients. Biol Blood Marrow Transplant 2016; 22: 1299–1305.

    PubMed  Google Scholar 

  92. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M et al. Gait speed and survival in older adults. JAMA 2011; 305: 50.

    CAS  PubMed  PubMed Central  Google Scholar 

  93. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000; 55: M221–M231.

    CAS  PubMed  Google Scholar 

  94. Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA . Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc 2007; 55: 1727–1734.

    PubMed  Google Scholar 

  95. Wennie Huang W-N, Perera S, VanSwearingen J, Studenski S . Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc 2010; 58: 844–852.

    PubMed  Google Scholar 

  96. Viccaro LJ, Perera S, Studenski SA . Is timed up and go better than gait speed in predicting health, function, and falls in older adults? J Am Geriatr Soc 2011; 59: 887–892.

    PubMed  PubMed Central  Google Scholar 

  97. Jones LW, Devlin SM, Maloy MA, Wood WA, Tuohy S, Espiritu N et al. Prognostic importance of pretransplant functional capacity after allogeneic hematopoietic cell transplantation. Oncologist 2015; 20: 1290–1297.

    PubMed  PubMed Central  Google Scholar 

  98. Syddall HE, Westbury LD, Dodds R, Dennison E, Cooper C, Sayer AA . Mortality in the Hertfordshire Ageing Study: association with level and loss of hand grip strength in later life. Age Ageing 2017; 46: 407–412.

    PubMed  Google Scholar 

  99. Gawel J, Vengrow D, Collins J, Brown S, Buchanan A, Cook C . The short physical performance battery as a predictor for long term disability or institutionalization in the community dwelling population aged 65 years old or older. Phys Ther Rev 2012; 17: 37–44.

    Google Scholar 

  100. Cesari M, Cerullo F, Zamboni V, Di Palma R, Scambia G, Balducci L et al. Functional status and mortality in older women with gynecological cancer. J Gerontol A Biol Sci Med Sci 2013; 68: 1129–1133.

    PubMed  Google Scholar 

  101. Brown JC, Harhay MO, Harhay MN . Physical function as a prognostic biomarker among cancer survivors. Br J Cancer 2015; 112: 194–198.

    CAS  PubMed  Google Scholar 

  102. Palumbo A, Bringhen S, Mateos M-V, Larocca A, Facon T, Kumar SK et al. Geriatric assessment predicts survival and toxicities in elderly myeloma patients: an International Myeloma Working Group report. Blood 2015; 125: 2068–2074.

    CAS  PubMed  PubMed Central  Google Scholar 

  103. Baitar A, Van Fraeyenhove F, Vandebroek A, De Droogh E, Galdermans D, Mebis J et al. Evaluation of the Groningen Frailty Indicator and the G8 questionnaire as screening tools for frailty in older patients with cancer. J Geriatr Oncol 2013; 4: 32–38.

    PubMed  Google Scholar 

  104. Smets IH, Kempen GI, Janssen-Heijnen ML, Deckx L, Buntinx FJ, van den Akker M et al. Four screening instruments for frailty in older patients with and without cancer: a diagnostic study. BMC Geriatr 2014; 14: 26.

    PubMed  PubMed Central  Google Scholar 

  105. Biganzoli L, Boni L, Becheri D, Zafarana E, Biagioni C, Cappadona S et al. Evaluation of the cardiovascular health study (CHS) instrument and the Vulnerable Elders Survey-13 (VES-13) in elderly cancer patients. Are we still missing the right screening tool? Ann Oncol Off J Eur Soc Med Oncol 2013; 24: 494–500.

    CAS  Google Scholar 

  106. Kenis C, Decoster L, Van Puyvelde K, De Grève J, Conings G, Milisen K et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 2014; 32: 19–26.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Brody School of Medicine at East Carolina University, Greenville, NC, USA

    A Hegde

  2. Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA

    H S Murthy

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  1. A Hegde
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  2. H S Murthy
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Correspondence to H S Murthy.

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Hegde, A., Murthy, H. Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?. Bone Marrow Transplant 53, 3–10 (2018). https://doi.org/10.1038/bmt.2017.192

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  • DOI: https://doi.org/10.1038/bmt.2017.192

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