HCT Frailty Scale for Younger and Older Adults Undergoing Allogeneic Hematopoietic Cell Transplantation

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.