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

Bone Marrow Transplantation volume 56, pages 60–69 (2021)Cite this article

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Abstract

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 × 106; 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.

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Fig. 1: Correlation between Frailty and Functionality parameters, overall survival (OS) and non-relapse mortality (NRM).

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Acknowledgements

We thank Dr. Hans Messner, a cherished physician who pioneered stem cell transplantation at Princess Margaret Cancer Centre. He provided the guidance and resources to initiate this pilot study. There is no funding to declare.

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Authors and Affiliations

  1. Department of Medicine, Section of Medical Oncology and Hematology, University of Toronto, Toronto, ON, Canada

    Maria Queralt Salas, Wilson Lam, Arjun Datt Law, Ivan Pasic, Dennis (Dong Hwan) Kim, Fotios V. Michelis, Zeyad Al-Shaibani, Armin Gerbitz, Auro Viswabandya, Jeffrey Howard Lipton, Jonas Mattsson & Rajat Kumar

  2. Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Maria Queralt Salas, Ora Bascom, Leeann Wilson, Wilson Lam, Arjun Datt Law, Ivan Pasic, Dennis (Dong Hwan) Kim, Fotios V. Michelis, Zeyad Al-Shaibani, Armin Gerbitz, Auro Viswabandya, Jeffrey Howard Lipton, Jonas Mattsson & Rajat Kumar

  3. Hematology Department, Institut Català d’Oncologia—Hospitalet, IDIBELL, Barcelona, Spain

    Maria Queralt Salas

  4. Department of Biostatistics, Princes Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Eshetu G. Atenafu

  5. Department of Medicine, University Health Network, Toronto, ON, Canada

    Shabbir M. H. Alibhai

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  1. Maria Queralt Salas
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Contributions

MQS and RK collected the data, made the figures and wrote the paper. RK designed the GA and the study. SA provided valuable input into GA assessment and study design. EA did the statistical analysis. OB, LW, ADL, WL, IP, ZAS, AG, DK, FVM, JHL, AV, and JM provided valuable input into the study design, analysis, and interpretation and reviewed the paper.

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Correspondence to Rajat Kumar.

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Salas, M.Q., Atenafu, E.G., Bascom, O. et al. Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 56, 60–69 (2021). https://doi.org/10.1038/s41409-020-0979-1

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