Hematology · 2 h ago
Frailty Predicts Lower Survival After Allogeneic Stem Cell Transplantation
A multicenter retrospective cohort study of 992 adults undergoing allogeneic hematopoietic cell transplantation found that higher HCT Frailty Scale scores were associated with lower two-year overall survival and higher nonrelapse mortality. Relapse incidence did not differ significantly by frailty category.
- Higher frailty was associated with lower two-year survival.
- Nonrelapse mortality rose with frailty category.
- Relapse incidence did not differ significantly.
- Disease-specific estimates were limited by small subgroups.
Researchers retrospectively studied 992 adults who underwent allogeneic hematopoietic cell transplantation at 16 centers in Canada and Spain between 2018 and 2023. Frailty was assessed at consultation using the Hematopoietic Cell Transplantation Frailty Scale (HCT-FS), categorizing patients as fit, prefrail, or frail. The cohort included six diagnostic categories; 4.8% had nonmalignant disorders.
At two years, overall survival was 78.9% among fit patients, 66.0% among prefrail patients, and 51.7% among frail patients (p<0.001). Nonrelapse mortality was 10.5%, 18.9%, and 33.2%, respectively (p<0.001). Compared with fit patients, adjusted nonrelapse mortality hazards were higher for prefrail patients (HR 1.77, 95% CI 1.21–2.60) and frail patients (HR 3.65, 95% CI 2.36–5.65). Two-year relapse incidence did not differ significantly across groups.
The findings support HCT-FS frailty as a prognostic marker for survival and nonrelapse mortality in this cohort, not relapse. The retrospective design limits causal interpretation, and disease-specific estimates were exploratory because some diagnostic subgroups were small; larger studies are needed, particularly for less represented indications.
In practice
For adults being evaluated for allogeneic hematopoietic cell transplantation, HCT-FS-defined frailty was associated with substantially lower two-year overall survival and higher nonrelapse mortality in this retrospective multicenter cohort. The scale may provide prognostic information for discussions of risk, but these findings do not establish that changing transplant eligibility or management based on the score improves outcomes. The study included diverse diagnoses, but disease-specific estimates were exploratory and limited by small subgroup sizes.
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European Journal of Haematology: HCT ‐ FS ‐Defined Frailty Is Associated With Lower Survival Across Diverse Hematologic Diagnoses After Allogeneic Transplantation ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.