Cancer treatment and research communications · 2025
At-home autologous hematopoietic cell transplant for adults with hematological malignancies. How frailty impacts and evolves during HCT procedure. An observational, longitudinal, and prospective study.
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Ortiz J, Solano MT, Gallego C, Ballestar N, de Llobet N, Guardia L, Salinas R, Martínez-Roca A, Merchán B, Charry P, Cid J, Lozano M, Carreras E, Laxe S, Closa C, Suárez-Lledó M, Rosiñol L, Martínez C, Rovira M, Fernández-Avilés F, Salas MQ
Аннотация
INTRODUCTION AND AIMS: Since April 2021, the frailty state of patients is evaluated routinely in adults undergoing auto-HCT at our institution using the HCT Frailty Scale. The scale categorises each candidate as either fit, pre-fit or frail.
METHODS: Our study includes 80 consecutive adults with lymphoprolipherative disorders (LPD) and multiple myeloma (MM) undergoing at-home auto-HCT at our institution between June 2021 and June 2023. An initial evaluation of frailty was conducted at first consultation (pre-apheresis), followed by a subsequent evaluation at day +100.
RESULTS: The median age was 58 years (range: 19-69), 41 (51.2 %) patients were males, 45 (56.3 %) were diagnosed with MM and 35 with LPD. At the initial consultation, 24 (30.0 %) adults were classified as fit, 48 (60.0 %) as pre-frail, and 8 (10.0 %) as frail. Frail patients were more likely to be older (OR 1.16 P = 0.077), and to have a KPS < 90 % (OR 27, P = 0.012), and also exhibit a higher number of comorbidities (HCT-CI>3: OR 11.9, p = 0.035). However, the underlying diagnosis did not impact the incidence of frailty at the initial consultation (OR 0.99, p = 0.999).
CONCLUSIONS: There was no association between the duration of at-home transplant hospitalisation and readmissions and the presence of frailty syndrome. Moreover, no patient died due to transplant-related toxicity. The results presented in this study support that at-home auto-HCT can be performed in fit, pre-frail, and frail adults with an experienced and multidisciplinary team. Although conclusions are limited by the reduced sample size, the observed differences on frailty incidences during patient's follow-up support that frailty is dynamic, and potentially amendable with specific interventions.
METHODS: Our study includes 80 consecutive adults with lymphoprolipherative disorders (LPD) and multiple myeloma (MM) undergoing at-home auto-HCT at our institution between June 2021 and June 2023. An initial evaluation of frailty was conducted at first consultation (pre-apheresis), followed by a subsequent evaluation at day +100.
RESULTS: The median age was 58 years (range: 19-69), 41 (51.2 %) patients were males, 45 (56.3 %) were diagnosed with MM and 35 with LPD. At the initial consultation, 24 (30.0 %) adults were classified as fit, 48 (60.0 %) as pre-frail, and 8 (10.0 %) as frail. Frail patients were more likely to be older (OR 1.16 P = 0.077), and to have a KPS < 90 % (OR 27, P = 0.012), and also exhibit a higher number of comorbidities (HCT-CI>3: OR 11.9, p = 0.035). However, the underlying diagnosis did not impact the incidence of frailty at the initial consultation (OR 0.99, p = 0.999).
CONCLUSIONS: There was no association between the duration of at-home transplant hospitalisation and readmissions and the presence of frailty syndrome. Moreover, no patient died due to transplant-related toxicity. The results presented in this study support that at-home auto-HCT can be performed in fit, pre-frail, and frail adults with an experienced and multidisciplinary team. Although conclusions are limited by the reduced sample size, the observed differences on frailty incidences during patient's follow-up support that frailty is dynamic, and potentially amendable with specific interventions.