Work

The Prevalence and Impact of Pre-Transplant Frailty and Mental Distress on Outcomes in Hematopoietic Cell Transplantation

Year: 2024

Type: article

Abstract: Frailty is a phenotype of decreased physiologic reserve affecting 10% of adults >65 years. In hematopoietic cell transplantation (HCT) recipients, frailty has been associated with a higher toxicities and non-relapse-mortality (NRM). The incidence, predictors, and adverse effects of pre-HCT frailty in adult recipients are not well known. Our primary aim was to evaluate the association of pre-HCT frailty with age and baseline characteristics in patients ≥18y undergoing autologous (auto) or allogeneic (allo) HCT for hematological malignancies at University of MN from 5/20 to 10/22. Patients had frailty assessments 2 weeks prior to HCT. Frailty was defined using Fried's criteria with ≥3 of the following: unintentional weight loss, exhaustion, slow walking speed, low physical activity and weakness. Secondary aims were to evaluate: association of depression and anxiety as measured by patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) scales with frailty; impact of frailty on health care utilization; impact of frailty on NRM and overall survival (OS). A total of 300 patients were analyzed (n=162 auto, n=138 allo). Allo patients were younger with median age 59 vs. 64. The overall prevalence of frailty was 18% pre-HCT (14.9% of auto and 21.6% of allo recipients), with similar distribution of frailty domains (Table 1). In the allo cohort frail patients were: older, predominantly male, KPS <90, higher PHQ-9 score, and had longer initial HCT hospital stay. In the auto cohort frail patients had: KPS <90 and higher PHQ-9 score. In regression analysis, older age was a significant predictor of frailty (OR 1.37 95% CI 1.02-1.82, p=0.035. Other factors independently associated with higher frailty included alloHCT (OR 2.03 (CI 1.07-3.84, p=0.03), and PHQ-9 score ≥ 10 (OR 6.28, CI 1.93-20.43, p=0.002). The 1 year OS probability was 83% (CI 70-91) in frail vs. 92% (CI 88-95) in non-frail recipients (p=0.04) Figure 2. Frailty was associated with non-significantly higher 1-year NRM (11% vs. 5%), with similar relapse. We report on high prevalence of frailty in the pre-HCT population of all age groups. Our analysis indicates that older age is a risk factor for frailty, as well as alloHCT recipients, and preexisting moderate/severe depression but not higher comorbidity index. Frailty is associated with a lower survival and higher health care utilization, indicating the need for early assessments and targeted interventions for this vulnerable population.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2024.01.018