Salas María Queralt, Solano María Teresa, Baile González Mónica, Acera Gómez Marina, Fox Laura, Pérez Artigas María Del Mar, Santamaría Ana, Quintela González María Del Carmen, Sánchez Salinas Andrés, Salmerón Camacho Joaquina M, Illana Álvaro Verónica, Abdallahi-Lefdil Zahra, Cornago Navascues Javier, Pardo Laura, Fernández-Luis Sara, Vega Suárez Leddy Patricia, Villar Sara, Beorlegui-Murillo Patricia, Esquirol Albert, Izquierdo García Isabel, Rodríguez González Sonia, Mussetti Alberto, Lavilla Esperanza, Lopez-Marín Javier, Filaferro Silvia, Cedillo Ángel, Bento Leyre, Sureda Anna
Unidad de Trasplante de Progenitores Hematopoyéticos, Servicio de Hematología, Hospital Clínic de Barcelona, Barcelona, Spain.
Servicio de Hematología, Complejo Asistencial Universitario de Salamanca/IBSAL, Salamanca, Spain.
Front Immunol. 2025 Jan 7;15:1512154. doi: 10.3389/fimmu.2024.1512154. eCollection 2024.
This multicenter prospective study sponsored by the (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. Based on the results, patients were classified into fit, pre-frail and frail categories. Allo-HCT outcomes were analyzed according to the results obtained from the HCT Frailty Scale. Data was collected prospectively and all patients signed informed consent.
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 at HCT admission 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.
这项由具体机构名称未给出资助的多中心前瞻性研究探讨了衰弱评估在异基因造血细胞移植（allo-HCT）候选者中的应用。
在西班牙15个造血细胞移植项目的404名成年人首次咨询和造血细胞移植入院时，使用造血细胞移植衰弱量表测量衰弱程度。根据结果，将患者分为健康、脆弱前期和脆弱类别。根据造血细胞移植衰弱量表的结果分析异基因造血细胞移植的结局。数据前瞻性收集，所有患者均签署知情同意书。
首次咨询时，102名（26.2%）患者被分类为健康，248名（61.4%）为脆弱前期，50名（12.4%）为脆弱。在研究期间，62名（15.2%）患者参加了预康复计划。在未参加预康复的患者（n = 342）中，健康患者的比例从26.6%降至16.7%，而脆弱患者从12.7%增至19.9%。相比之下，参加预康复的患者（n = 62）有所改善，健康患者从24.2%增至46.8%，脆弱患者从9.7%降至3.2%。多因素分析证实，与健康患者相比，造血细胞移植入院时脆弱患者的总生存期较低（风险比[HR] 2.52，P = 0.002），非复发死亡率较高（HR 2.69，P = 0.013），脆弱前期患者的总生存期有降低趋势（HR 1.54，P = 0.097）。
本研究强调了将造血细胞移植衰弱量表纳入临床实践的可行性，证实了衰弱对移植结局的负面影响，并表明衰弱是动态的，通过移植前干预可能是可逆的。
