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HCT frailty scale for younger and older adults undergoing allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 58, pages 1237–1246 (2023)Cite this article

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Abstract

The HCT Frailty Scale is an easy prognostic tool composed of (a) Clinical Frailty Scale; (b) Instrumental Activities of Daily Living; (c) Timed-up-and-Go test; (d) Grip Strength; (e) Self-Health Rated Questionnaire; (f) Falls tests; (g) Albumin and C-reactive protein levels. This scale was designed to classify allogeneic hematopoietic cell transplant (alloHCT) candidates into fit, pre-frail and frail groups, irrespective of age. This study evaluates the ability of this frailty classification to predict overall survival (OS) and non-relapse mortality (NRM) in adult patients of all ages, in a prospective sample of 298 patients transplanted between 2018 and 2020. At first consultation, 103 (34.6%) patients were fit, 148 (49.7%) pre-frail, and 47 (15.8%) were frail. The 2-year OS and NRM of the three groups were 82.9%, 67.4%, and 48.3% (P < 0.001), and 5.4%, 19.2%, and 37.7% (P < 0.001). For patients younger than 60 years (n = 174), the 2-year OS and NRM of fit, pre-frail, and frail groups were 88.4%, 69.3% and 53.1% (P = 0.002), and 5.8%, 22.8%, and 34.8% (P = 0.005), respectively; and in patients older than 60 (n = 124), OS and NRM were 75.5%, 63.8% and 41.4% (P = 0.006), and 4.9%, 16.4%, and 42.1% (P = 0.001). In conclusion, frailty predicted worse transplant outcomes in both younger and older adults.

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Acknowledgements

We thank Dr. Hans Messner, a cherished physician who pioneered stem cell transplantation at Princess Margaret Cancer Centre, and provided the guidance and resources to initiate this study. In addition, we thank our patients and the nursing and support staff in the Hans Messner Allogeneic Blood and Marrow Transplant Program.

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

  3. HCT Unit, Hospital Clinic de Barcelona, ICHMO, 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, 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, provided valuable input into the interpretation of the results 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. HCT frailty scale for younger and older adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 58, 1237–1246 (2023). https://doi.org/10.1038/s41409-023-02088-z

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