Post-Transplant Frailty Phenotype Predicts Survival

• Published in: Transplantation and cellular therapy 2024-02, Vol.30 (2), p.S407-S408
• Main Authors: Hadjis, Ashley D., White, Griffin W., Gill, Saar I., Hossain, Nasheed, Frey, Noelle V., Hexner, Elizabeth O, Bruno, Ximena Jordan, Lai, Catherine E, Matthews, Andrew H., Martin, Mary Ellen, Babushok, Daria V., Perl, Alexander E., Pratz, Keith W., Luger, Selina M., Porter, David L., Loren, Alison W., McCurdy, Shannon R.
• Format: Article
• Language: English
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2023.12.575

Hematopoietic cell transplant (HCT) is a potentially curative treatment for hematologic malignancies, diseases largely of older adults. However, older adults are often excluded from this life-saving treatment because of a higher risk of post-HCT mortality and physical decline. Here we examined how fitness changes in older adults post-HCT and how post-HCT frailty status influences survival. Ninety-six HCT recipients with either acute leukemia or myelodysplastic syndrome who were 60 years or older were prospectively enrolled at our institution. Fried's Frailty Phenotype (FFP) was assessed prior to conditioning and at 1, 3, 6, and 12 months post-HCT. The median age of the cohort was 67 (range 60-78) years. Patients had multiple comorbidities and high-risk disease features: 54.2% had a hematopoietic cell transplant specific comorbidity index (HCT-CI) ≥3 and 94.8% of patients had a disease risk index (DRI) of either intermediate or high/very high risk. By FFP, 32.3% were fit, 60.4% were pre-frail, and 7.3% were frail prior to conditioning start. Overall survival (OS) was 72% at one-year and 58% at two-years for the entire cohort. At 1-month post-HCT, 8.9% of patients were fit, 46.4% were pre-frail, and 44.6% were frail. At 6-months, 11.8% were fit, 60.8% were pre-frail, and 27.5% were frail. The vast majority of patients had a decline in their FFP from pre-HCT to 1-month post-HCT and these declines often persisted until 6 months post-HCT before starting to rebound in surviving patients. FFP at one- (p=0.0215) and six- (p=0.0096) months post-HCT was significantly associated with OS when comparing pre-frail to frail patients (Figure 1). Fit patients were excluded from post-HCT FFP OS analysis due to very low numbers. 1- and 2-year OS were 87.2% and 82.4% for patients who were pre-frail and 71.1% and 46% for patients who were frail at 1-month post-HCT. 1- and 2-year OS were 93.3% and 86.1% for patients who were pre-frail and 71.4% and 42.9% for patients who were frail at 6-months post-HCT. Patients who were pre-frail at 1-month post-HCT were more likely to die from disease (80%), than other causes including graft-versus-host disease (GVHD) (20%). Frail patients still died from disease (50%) at high rates, but died from infection (14.3%) more often than pre-frail patients, with the remainder dying from other causes (35.7%). The association of post-HCT FFP and survival was independent of DRI. Post-HCT FFP may be an important predictive marker of OS. An ongoing study