Incorporating Frailty Testing As Part of Pre-Transplant Evaluation for Allogeneic Stem Cell Transplant: Challenges and Future Direction

Abstract

Background The widespread adoption of reduced-intensity conditioning regimens have resulted in increased transplant rates among older patients. The utilization of Hematopoietic Cell Transplantation Comorbidity Index (HCT- CI) may not fully predict older patients' physical and physiological status. Hence there is a need for a frailty assessment tool to better predict older patients' risk of transplant-related mortality (TRM) and inform risk-benefit discussions prior to transplant. Methods We instituted the use of frailty test for allogeneic stem cell recipients older than age 60. The frailty test has a cognitive and a physical component. Three tests make up the physical performance: the semi-tandem/tandem stand for 10 seconds, the timed 8 ft walk, and a timed sit to stand from chair 5 times. We evaluated 17 patients that had reportable scores. The median age was 65 years (range 62-72), primary indication for transplant was AML (60%). Fourteen patients received a reduced-intensity conditioning regimen, and stem cell source was matched unrelated donor in 52% of the patients. Results Of the 17 patients, 12 had both cognitive and physical scores documented and the remaining 5 only had the cognitive portion documented. The maximum physical performance score is 12. The average score was 9.5, (range 6 to 12). The maximum score for the cognitive portion is 100. The average score was 97, (range 92-100). The average comorbidity index was 2.375, (range 0-6). On the first day of the conditioning regimen, the average Karnofsky score was 82%, (range 70-100%; and the average albumin level was 4, (range 3.4 to 4.7). In the peri-transplant time period, 1 patient had a fall while inpatient. Zero patients were discharged to rehab from the hospital. Conclusion We found that the frailty test was not well standardized. We discovered barriers in communicating, interpreting and adoption of the frailty test. We are continuing to evaluate the correlation of the frailty scores and the TRM at 1 year.