Brody School of Medicine at East Carolina University, Greenville, NC, USA.
Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Bone Marrow Transplant. 2018 Jan;53(1):3-10. doi: 10.1038/bmt.2017.192. Epub 2017 Oct 30.
Hematopoietic stem cell transplantation (HSCT) represents a curative option for those afflicted with numerous hematologic malignancies and bone marrow failure syndromes. Advances and refinement of the HSCT process have resulted in increasing number of transplants performed on older patients in the recent years. Pre-transplant assessments (PTA) function to risk stratify patients prior to undergoing HSCT in an effort to predict those at higher risk of treatment-related toxicity, to inform risk/benefit assessments and to aid clinical decision making. Traditionally used risk stratification parameters such as chronologic age, comorbidity and performance status may not fully capture physical function, physiologic fitness, highlighting a need for improvement in PTA. Incorporation of frailty measurements in pre-HSCT assessments, particularly in elderly transplant candidates, may result in improving predictive ability of existing tools such as the Hematopoietic Cell Transplantation Comorbidity Index and Karnofsky performance status. Here, we review existing pre-HSCT assessment tools, measures of frailty that may aid in risk stratification for patients undergoing HSCT and directions for future research using frailty in the pre-HSCT setting.
造血干细胞移植 (HSCT) 是许多血液系统恶性肿瘤和骨髓衰竭综合征患者的一种治疗选择。近年来，HSCT 技术的进步和完善使得越来越多的老年患者接受了移植。移植前评估 (PTA) 的作用是在进行 HSCT 之前对患者进行风险分层，以预测那些治疗相关毒性风险较高的患者，为风险/获益评估提供信息，并辅助临床决策。传统的风险分层参数，如年龄、合并症和体能状态等，可能无法完全反映身体功能和生理适应性，因此需要改进 PTA。在 HSCT 前评估中纳入脆弱性测量，特别是在老年移植候选者中，可能会提高现有工具（如造血细胞移植合并症指数和 Karnofsky 体能状态）的预测能力。在这里，我们回顾了现有的 HSCT 前评估工具、可能有助于 HSCT 患者风险分层的脆弱性测量方法，以及在 HSCT 前环境中使用脆弱性的未来研究方向。
