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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1512154

Frailty Assessment in Adults Undergoing Allogeneic Hematopoietic Cell Transplantation: Insights from a Multicenter GETH-TC Study to Optimize Outcomes and Care

Provisionally accepted
Maria Queralt Salas Maria Queralt Salas 1*María Teresa Solano María Teresa Solano 1Mónica Baile González Mónica Baile González 2Marina Acera Gómez Marina Acera Gómez 2Laura Fox Laura Fox 3María Del Mar Pérez-Artigas María Del Mar Pérez-Artigas 3Ana Santamaría Ana Santamaría 4María Del Carmen Quintela González María Del Carmen Quintela González 4Andrés Sánchez Salinas Andrés Sánchez Salinas 5Joaquina M Salmerón Camacho Joaquina M Salmerón Camacho 5Verónica Illana Álvaro Verónica Illana Álvaro 6Zahra Abdallahi-Lefdil Zahra Abdallahi-Lefdil 6Javier Cornago Navascues Javier Cornago Navascues 7Laura Pardo Laura Pardo 7Sara Fernández-Luis Sara Fernández-Luis 8Leddy Patricia Vega-Suárez Leddy Patricia Vega-Suárez 8Sara Villar Fernandez Sara Villar Fernandez 9Patricia Beorlegui-Murillo Patricia Beorlegui-Murillo 9Albert Esquirol Albert Esquirol 10Isabel Izquierdo García Isabel Izquierdo García 11Sonia González Rodríguez Sonia González Rodríguez 12Alberto Mussetti Alberto Mussetti 12Esperanza Lavilla Rubira Esperanza Lavilla Rubira 13Javier Lopez- Marín Javier Lopez- Marín 14Silvia Filaferro Silvia Filaferro 15Ángel Cedillo Ángel Cedillo 15Leyre Bento Leyre Bento 16Anna Sureda Anna Sureda 12
  • 1 Hospital Clinic of Barcelona, Barcelona, Spain
  • 2 University Hospital of Salamanca, Salamanca, Spain
  • 3 Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
  • 4 Alvaro Cunqueiro Hospital, Pontevedra, Spain
  • 5 Virgen de la Arrixaca University Hospital, Murcia, Murcia, Spain
  • 6 Princess University Hospital, Madrid, Madrid, Spain
  • 7 University Hospital Fundación Jiménez Díaz, Madrid, Madrid, Spain
  • 8 Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain
  • 9 Servicio de Hematología, Clínica Universitaria de Navarra, Pamplona, Navarre, Spain
  • 10 Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
  • 11 Hospital Universitario Miguel Servet, Zaragoza, Aragon, Spain
  • 12 Catalan Institute of Oncology, Barcelona, Catalonia, Spain
  • 13 Lucus Augusti University Hospital, Lugo, Spain
  • 14 Hospital General Universitario de Alicante, Alicante, Spain
  • 15 Grupo Español de Trasplante de Progenitores Hematopoyéticos y Terapia Celular, Madrid, Spain
  • 16 Hospital Universitario Son Espases, Palma de Mallorca, Spain

The final, formatted version of the article will be published soon.

    This multicenter prospective study sponsored by the Grupo Español de Transplante Hematopoyético y Terapia Celular (GETH-TC) explores the use of frailty assessments in allo-HCT candidates. Frailty was measured using the HCT Frailty Scale at first consultation and HCT admission in 404 adults from 15 HCT programs in Spain. At first consultation, 102 (26.2%) patients were classified as fit, 248 (61.4%) as pre-frail, and 50 (12.4%) as frail. During the study, 62 (15.2%) patients participated in a pre-habilitation program. Among non-pre-habilitated patients (n=342), the proportion of fit patients decreased from 26.6% to 16.7%, while frail patients increased from 12.7% to 19.9%. In contrast, pre-habilitated patients (n=62) showed improvements, with fit patients increasing from 24.2% to 46.8%, and frail patients decreasing from 9.7% to 3.2%. Multivariate analysis confirmed lower OS (HR 2.52, P=0.002) and higher NRM (HR 2.69, P=0.013) in frail patients compared to fit ones, with a trend towards lower OS in pre-frail patients (HR 1.54, P=0.097). This study highlights the feasibility of incorporating the HCT Frailty Scale into clinical practice, confirms its negative impact of frailty on transplant outcomes, and suggests that frailty is dynamic and potentially reversible through pre-transplant interventions.

    Keywords: frailty syndrome, HCT Frailty Scale, Allogeneic-HCT, pre-habilitation, Survival

    Received: 16 Oct 2024; Accepted: 12 Dec 2024.

    Copyright: © 2024 Salas, Solano, Baile González, Acera Gómez, Fox, Pérez-Artigas, Santamaría, Quintela González, Sánchez Salinas, Salmerón Camacho, Illana Álvaro, Abdallahi-Lefdil, Cornago Navascues, Pardo, Fernández-Luis, Vega-Suárez, Villar Fernandez, Beorlegui-Murillo, Esquirol, Izquierdo García, González Rodríguez, Mussetti, Lavilla Rubira, Lopez- Marín, Filaferro, Cedillo, Bento and Sureda. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Maria Queralt Salas, Hospital Clinic of Barcelona, Barcelona, Spain

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.