The Assessment of Frailty in Adults Undergoing Allogeneic Hematopoietic Cell Transplantation Can Help to Improve Outcomes and Supportive Care. Study on Behalf of the Grupo Español de Trasplante Hematopoyético y Terapia Celular

Abstract This prospective and multicenter study implements the HCT Frailty Scale at first consultation and HCT admission in 384 consecutive adults undergoing allo-HCT at 15 HCT programs across Spain and investigates the applicability of evaluating frailty in allo-HCT. At first consultation, 102 (26.6%) patients were classified as fit, 233 (60.7%) as pre-frail and 49 (12.8%) as frail. During the study period, 61 (15.8%) patients joined a pre-habilitation program. From first consultation to HCT admission, among non-pre-habilitated patients (n=323), the proportion of fit patients decreased from 27.6% to 17.6%, while pre-frail and frail patients increased (from 59.8% to 63.7% and 12.7% to 19.2%, respectively). In contrast, among those in pre-habilitation (n=61), fit patients increased (from 21.3% to 42.6%), while the proportions of pre-frail and frail patients decreased (from 65.6% to 50.8% and 13.1% to 6.6%). Multivariate analysis including frailty information obtained at HCT admission confirmed lower OS (HR 3.02, P=0.004) and higher NRM (HR 2.79, P=0.03) in frail patients compared to fit ones, with pre-frail patients showing a tendency towards lower OS (HR 1.74, P=0.092). Results from this study confirm the predictive power of the HCT Frailty Scale for transplant outcomes, and reveal the dynamic nature of frailty in allo-HCT candidates.