HCT
‐
FS
‐Defined Frailty Is Associated With Lower Survival Across Diverse Hematologic Diagnoses After Allogeneic Transplantation
Tommy Alfaro Moya, María Queralt Salas, Ivan Pasic, Mónica Baile González, Marina Acera Gómez, Laura Fox, María del Mar Pérez Artigas, Ana Santamaría, María del Carmen Quintela González, Andrés Sánchez Salinas, Joaquina M. Salmerón Camacho, Verónica Illana Álvaro, Zahra Abdallahi‐Lefdil, Javier Cornago Navascues, Laura Pardo, Sara Fernández‐Luis, Leddy Patricia Vega Suárez, Sara Villar, Patricia Beorlegui‐Murillo, Albert Esquirol, Isabel Izquierdo García, Alberto Mussetti, Esperanza Lavilla, Javier Lopez‐Marín, Silvia Filaferro, Pascual Balsalobre, Leyre Bento, Auro Viswabandya, Fotios V. Michelis, Eshrak Al Shaibani, Igor Novitzky‐Basso, Jonas Mattsson, Shabbir Alibhai, Montserrat Rovira, Dennis Kim, Anna Sureda, Rajat Kumar ABSTRACT
Objectives
To evaluate whether Hematopoietic Cell Transplantation Frailty Scale (HCT‐FS)‐defined frailty predicts overall survival (OS), nonrelapse mortality (NRM), and relapse across diverse hematologic diagnoses undergoing allogeneic hematopoietic cell transplantation (alloHCT), including nonmalignant disorders.
Methods
We conducted a multicenter retrospective cohort study of 992 adults undergoing alloHCT at 16 centers in Canada and Spain (2018–2023). Frailty was assessed at consultation using the HCT‐FS (fit, prefrail, frail). OS was estimated by Kaplan–Meier, competing‐risks methods by cumulative incidence. Multivariable models assessed associations with OS and NRM.
Results
Frailty was assessed across six diagnostic categories, including nonmalignant disorders (4.8%). At consultation, 32.1% were fit, 54.7% prefrail, and 13.2% frail. Increasing frailty was associated with progressively lower 2‐year OS (78.9%, 66.0%, 51.7%; p < 0.001) and higher 2‐year NRM (10.5%, 18.9%, 33.2%; p < 0.001; HR 1.77 [95% CI 1.21–2.60] prefrail and 3.65 [2.36–5.65] frail vs. fit), while 2‐year relapse incidence did not differ (19.0%, 23.5%, 22.3%; p = 0.229). Disease‐specific estimates were exploratory and limited by small subgroup sizes.
Conclusions
HCT‐FS‐defined frailty is associated with OS and NRM but not relapse in this multicenter alloHCT cohort. Larger disease‐specific studies are needed to establish its prognostic value in less represented indications.