Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation

Abstract

Background. The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. Patients and Methods. Using a retrospective design, 407 patients completed a 6-minute walk distance (6MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6MWD category (,400 m vs. $400 m) and the change in 6MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. Results. Compared with ,400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96)

Use of geriatric assessment in hematopoietic cell transplant

“…Jones et al evaluated performance-based physical function in allogeneic HCT recipients with an objective measure, the 6-Minute Walk Test (6MWT), which has been shown to correlate with cardiopulmonary function [90]. Not only did they find this objective measure to be predictive of NRM and OS, they also found that a decline in 6MWT pre-HCT to post-HCT was associated with higher NRM [91].…”

Reprint of: Aging: Treating the Older Patient

“…In studies of adult patients of all ages, cardiopulmonary fitness tools of 6-minute walk distance or cycle ergometry may risk-stratify patients [81,82]. Whether patient-reported function, performance-based function, or both will be optimal is unknown.…”

Biologic vs physiologic age in the transplant candidate

“…More extensive testing, such as a 6-minute walk test or provocative cardiopulmonary testing will better define various levels of functional capability. 22 Geriatric assessment (GA) consists of a multidimensional tool to evaluate numerous health domains of interest in older adults and have found widespread application in cancer. 23 Table 1 depicts typical domains in a GA and common instruments employed, recognizing that no standard GA exists.…”