Frailty: the missing piece of the pre- hematopoietic cell transplantation assessment?

Abstract

Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.

Pre-transplantation Risks and Transplant-Techniques in Haematopoietic Stem Cell Transplantation for Acute Leukaemia

“…Performance scores may fail to accommodate co-morbidities or the complex frailty of older patients [27]. Molecular, cytogenetic, and minimal residual disease status was not available, information which is especially relevant for individual decision-making [7].…”

Relationship between Aging and Hematopoietic Cell Transplantation

“…Compared with their age-matched peers, 50-year-old pre-HCT patients are more likely to be frail; frailty in this population is about 25%, more prevalent than that of the general geriatric population [32]. Frailty is thus not merely a result of HCT; it is also often a predisposing factor because of the patient's disease and treatment history.…”

Factors Affecting Quality of Life in Patients Receiving Autologous Hematopoietic Stem Cell Transplantation

“…Frailty is diagnosed when at least 3 of 5 phenotypic criteria are met: (1) weakness as measured by low grip strength, (2) slowed walking speed, (3) low level of physical activity, (4) low energy or self-reported exhaustion, and (5) unintentional weight loss. The prefrailty state, which carries a high risk of progression to frailty, is identified when 2 of 5 criteria are present 2 . Frailty increases an individual’s susceptibility to developing dependency and/or dying 3 .…”