Publication Date:
2015-12-03
Description:
Introduction: With improvements in transplant strategy and supportive care, hematopoietic cell transplantation (HCT) is increasingly being used to treat older patients (60-80 years). Frailty is a well-accepted phenomenon in the geriatric population characterized by diminished physiological reserve and increased vulnerability to stress, with strong associations with falls, disability, hospitalization and mortality. Since HCT is a substantial stressor, we hypothesized that the prevalence of frailty and pre-frailty will increase in the immediate post-transplant period, and that frailty will be associated with early (1y) post-transplant non-relapse mortality (NRM). Methods: We conducted a prospective, longitudinal study of 96 patients undergoing HCT at age 40y or older between February 2014 and April 2015, and serially performed a multi-domain geriatric assessment (incorporating function, comorbidity, cognition, psychological state, social activity/support, and nutritional status) in additional to demographic, transplant and disease related variables. Frailty was defined by presence of 3 or more of the following criteria: unintentional weight loss, exhaustion, weakness, slow walking speed and low physical activity; pre-frailty was defined by presence of 1 or 2 of the criteria. Geriatric assessments were performed pre-HCT and at 100 days, 6 months and 1 year post HCT. The prevalence of frailty and pre-frailty was evaluated at each time point in older (60-74y, n=48) vs. younger (40-59y, n=48) recipients. Longitudinal assessments (baseline, 100 days, 6 months, 1 year) of ordinal frailty measures were assessed using random effects and non-linear mixed logistic regression models. Impact of frailty on 1 year NRM was estimated using cumulative incidence estimates. Results: Older patients were more likely to undergo reduced intensity conditioning, and less likely to be employed at HCT. The prevalence of frailty increased with time since HCT: The prevalence of frailty was 8% at baseline and increased to 39% by 6 months (
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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