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Introduction: Frailty can adversely affect the outcomes of allogeneic hematopoietic stem cell transplantation (alloHSCT) but is difficult to measure in busy transplant clinics. The limited published studies have used dedicated trained persons and comprehensive geriatric assessment (GA) tools, which are time consuming (Muffly LS, Haematologica 2014; Holmes HM, J Geriatr Oncol 2014; Rodrigues M, J Geriatr Oncol 2019). The difficulty in application of GA tools by transplant clinicians, residents and nurses in their clinics has resulted in low adoption rates in routine practice. At our center we adopted selected tests for frailty and function which could be conducted during pre-transplant consultation in a busy clinic, without extra waiting time for patients, and using existing staff. The Timed up and Go test (TUGT) was adopted as it could be done in any closed clinic room, without need for a corridor. Thus it was considered safer than a gait speed test and was even applicable to patients in "isolation". We aim to share a preliminary analysis of the applicability and correlation between our selected frailty assessment with transplant outcomes and complications. Methods: Patients referred for transplant underwent the following assessments conducted by different providers. All ages were included. Relevant tests and source of data are as follows: Frailty and function by clinician evaluating (a) Clinical Frailty scale (CFS) with 9 points based on clinical judgement (Rockwood 2005) (b) Lawton's Instrumental activities of daily living (IADL). Objective physical performance by nursing BMT coordinator using (a) TUGT and (b) Grip strength using hydraulic "Jamar" hand dynamometer conducted in clinic room at time of documentation. Self assessment by patient completing (a) Self-rated health (SRH) question and (b) a question on falls. Blood tests (a) CRP (b) Albumin. The present study is a single center prospective observational study. Patients who did not proceed to transplant were excluded. Ninety-six consecutive adult allo-HSCT patients were eligible for the present analysis, updated on July 2019. The parameters were individually correlated with overall survival (OS), non-relapse mortality (NRM), cumulative incidence (cum.Inc) of acute GVHD, median time of transplant hospitalization and readmissions. Multivariate analysis was not performed in this pilot study due to limited number of patients and low frequency of adverse events. Results: Baseline characteristics and main post-transplant information are noted in Table 1. Median follow up of cohort was 5 months. Table 2 shows the main outcomes (with normal values). For the entire cohort the median OS at 6 months was 73.9% (range 61.7-82.8), NRM at day+100 was 8.7% (range 2.6-14.7), Cum.Inc of Acute GVHD 41.1% (range 30.1-52.1), Cum.Inc gr II-IV acute GVHD was 25.7% (range 15.6-35.9). Relapse occurred in 8 cases (8.3%) and deaths in 23 (23.9%). A TUGT of more than 10 seconds and raised CRP predicted poor OS (p<0.05). Abnormal TUGT, SRH question score of <A (excellent), lower albumin levels and raised CRP levels correlated with high NRM (p<0.05). A Clinical Frailty Score of more than 2, limitations of 1 or more IADLs, Grip strength below normal for age and sex, TUGT >10 seconds, SRH question <A, and lower albumin level were significant predictors for a longer median duration of transplant hospitalization. No frailty or functionality parameter correlated significantly with the Cum.Inc of any grade of acute GVHD, grade II-IV acute GVHD or the risk of rehospitalization after alloHSCT. Conclusions: Our pilot study shows that with selected brief tools, frailty and functionality can be assessed as part of routine clinical practice in allogeneic-stem cell transplantation in all age groups without extra waiting time for patients or additional human resources. TUGT is a useful prognostic tool which can be conducted in a clinic room and correlates with OS, NRM, and duration of hospitalization. Larger number of patients and longer follow-up will help to evaluate the different assessment modalities as prognostic tools in allo-HSCT and their wider applicability. Disclosures Michelis: CSL Behring: Other: Financial Support. Mattsson:Gilead: Honoraria; Celgene: Honoraria; Therakos: Honoraria.

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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INTRODUCTION Frailty in patients undergoing hematopoietic cell transplantation (HCT) has a negative impact on survival. The inclusion of frailty evaluations before HCT is highly recommended; however, there is no consensus about the best methodology to evaluate this syndrome. In 2018 our center started a Frailty and Functionality program that involves regularly collecting information on the following eight indices in patients referred for allogeneic HCT (Salas et al., 2021): Clinical Frailty Scale (CFS), Instrumental Activities of Daily Living (IADL) test, Timed up and Go Test (TUGT), Grip Strength (GS), Self-Health Rated questionnaire (SHR-Q), Fall test, albumin (Alb), and C - reactive protein (CRP). With the recorded measurements of the eight indices and the corresponding validating process, we propose a HCT Frailty Scale. This scale is specifically designed to identify fit, pre-frail, and frail candidates for alloHCT, from better to worst probability of post-transplant survival. METHODS Between June 2018 and December 2020, 338 adults underwent alloHCT at our Institution. Frailty syndrome was evaluated prospectively in all patients at first consultation, using existing resources, after informed consent. It included measurement of the eight indices. The median time to evaluate was 5-6 minutes. Each index was given a value of 0 if normal or 1 (abnormal). Complete data were available for 298 patients that were finally included in the analysis. With this data the HCT Frailty Scale was elaborated as follows. The study cohort was split in two groups, a training cohort with 2/3 (N=200) of the patients, and a validation cohort of 1/3 (N=98), proportional to death outcomes. With the data from the training group we estimated a multivariable Cox model with overall survival (OS) as dependent variable, and the eight referenced indices as explanatory variables. Any normal result was scored 0, and based on the estimated HR coefficient from the Cox model, a proportional weight score was given to each respective index variable in the calculation of the composite HCT Frailty Scale score. The HCT Frailty index was calculated using the following formula: 1.5 *CFS, +1*IADL, +1*GS, + 1.5*TUGT, + 1*SHR-Q, +1*Falls-Test, + 1.5 *Alb, + 2*CRP. As a result, the HCT Frailty Scale goes from 0 to 10.5. The values of the scale were grouped to determine the following three groups of patients: (a) Fit patent: scale score ≤1; (b) Pre-Frail patient: 1&lt; scale score &lt; 5.5; (c) Frail patient: scale score 5.5 (Figure 1). RESULTS Baseline characteristics of the training and validation cohort are shown in Figure 1. Of the 200 patients included in the training cohort, the median age was 58 years (range 19-76 years); 29 (15.85%) had a KPS between 70-80%; and 56 (30.11%) a HCT-CI &gt;3. The elaborated HCT Frailty Scale classified the 200 patients as: (a) 70 (35%) fit patients with an estimated 1-y OS of 83.7%; (b) 97 (48.5%) pre-frail patients with a predicted 1-y OS of 75.6%; and (c) 33 (16.5%) frail patients with an estimated 1-y OS of 52.8%. Of the 33 frail patients, 54.8% had a KPS between 90-100% and 48.5% had an HCT-CI &lt;3 and of the 70 fit patients, 4.8% had a KPS between 70-80% and 24.2% had an HCT-CI ≥ 3. These differences support the hypothesis that frailty does not necessarily correlate with performance and comorbidities. The predictive ability of the HCT Frailty Scale was validated in 98 patients included in the validation cohort. This scale identified (a) 33 (33.7%) fit patients with an expected 1-y OS of 90.3%, (b) 51 (52%) pre-frail patients with an expected 1-y OS of 69.5%, and (c) 14 (14%) frail patients with an estimated 1y OS of 46.2% (Figure 1). CONCLUSION The HCT Frailty Evaluation Scale has been specifically designed to be applied in routine clinical practice and to patients across all ages. The scale ranges from 0 to 10.5 and the score value is calculated as the weighted sum of values of eight indexes evaluated at first consultation. The proposed scale should be of utility to identify frail and pre-frail patients that may benefit from appropriate counselling pre-transplant and individualized interventions to reverse frailty syndrome prior to alloHCT. Figure 1 Figure 1. Disclosures Law: Novartis: Consultancy; Actinium Pharmaceuticals: Research Funding. Kim: Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Paladin: Honoraria, Research Funding; Bristol-Meier Squibb: Research Funding; Pfizer: Honoraria, Research Funding. Lipton: Bristol Myers Squibb, Ariad, Pfizer, Novartis: Consultancy, Research Funding. Mattsson: MattssonAB medical: Current Employment, Current holder of individual stocks in a privately-held company.

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