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Impact of hematopoietic cell transplant frailty scale on transplant outcome in adults

Bone Marrow Transplantation volume 58, pages 317–324 (2023)Cite this article

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Abstract

This prospective study designs an HCT Frailty Scale to classify alloHCT candidates into groups of frail, pre-frail, and fit, and to be implemented in the first consultation at no additional cost. The present scale is composed of the following eight variables: Clinical Frailty Scale, Instrumental Activities of Daily Living, Timed Up and Go Test, Grip Strength, Self-Health Rated, Falls, Albumin, and C-Reactive Protein. The Frailty score of a patient is the weighted sum of scores for each item, with weights assigned according to the hazard ratios of a multivariable Cox proportional hazards model estimated and validated with data on OS as the dependent variable, and the scores of the eight variables as explanatory ones, from 298 adults split into training (n = 200) and validation (n = 98) sets. For clinical use, the scale scores were transformed into three categories: scale score ≤1: fit; 1<scale score ≤5.5: pre-frail; scale score >5.5 frail. The estimated probabilities of 1-year OS in each group of frailty, were, respectively: 83.7%, 48.5%, and 16.5% (p < 0.001). In the validation cohort, the respective values were 90.3%, 69.5%, and 46.2% (p < 0.001). Pending further external validations, the HCT Frailty Scale is a low cost-highly informative prognostic signal of outcomes at the pre-transplant stage.

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Fig. 1: Frailty and Functionality Program at Our Institution.
Fig. 2: Overall survival and non-relapse mortality of the training cohort and validation cohort according to the HCT frailty scale.

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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.

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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, Ivan Pasic, Eshrak Al-Shaibani, Carol Chen, Arjun Datt Law, Wilson Lam, Igor Novitzky-Basso, Dennis (Dong Hwan) Kim, Armin Gerbitz, Auro Viswabandya, Fotios V. Michelis, 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, Ivan Pasic, Eshrak Al-Shaibani, Ora Bascom, Leeann Wilson, Carol Chen, Arjun Datt Law, Wilson Lam, Igor Novitzky-Basso, Dennis (Dong Hwan) Kim, Armin Gerbitz, Auro Viswabandya, Fotios V. Michelis, Jeffrey Howard Lipton, Jonas Mattsson & Rajat Kumar

  3. Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, 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 Alibhai

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Contributions

MQS and RK collected the data, interpreted the results, and wrote the paper. RK and MQS designed the HCT Frailty scale. RK designed the GA and the study. SA provided valuable input into GA assessment and study design. EA did the statistical analysis, interpreted the results, and provided valuable input into the interpretation and reviewed the manuscript. IP, EAS, OB, LW, CC, ADL, WL, INB, DDHK, AG, AV, FVM, JHL, and JM provided valuable input into the interpretation and reviewed the manuscript.

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Correspondence to Rajat Kumar.

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Salas, M.Q., Atenafu, E.G., Pasic, I. et al. Impact of hematopoietic cell transplant frailty scale on transplant outcome in adults. Bone Marrow Transplant 58, 317–324 (2023). https://doi.org/10.1038/s41409-022-01892-3

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