At-home autologous hematopoietic cell transplant for adults with hematological malignancies. How frailty impacts and evolves during HCT procedure. An observational, longitudinal, and prospective study

Q3 Medicine

Cancer treatment and research communications Pub Date : 2025-01-01 DOI:10.1016/j.ctarc.2025.100920

Juan Ortiz , María Teresa Solano , Cristina Gallego , Nuria Ballestar , Noemi de Llobet , Laia Guardia , Raquel Salinas , Alexandra Martínez-Roca , Beatriz Merchán , Paola Charry , Joan Cid , Miquel Lozano , Enric Carreras , Sara Laxe , Concepción Closa , María Suárez-Lledó , Laura Rosiñol , Carmen Martínez , Montserrat Rovira , Francesc Fernández-Avilés , María Queralt Salas

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引用次数: 0

Abstract

Introduction and aims

Since April 2021, the frailty state of patients is evaluated routinely in adults undergoing auto-HCT at our institution using the HCT Frailty Scale. The scale categorises each candidate as either fit, pre-fit or frail.

Methods

Our study includes 80 consecutive adults with lymphoprolipherative disorders (LPD) and multiple myeloma (MM) undergoing at-home auto-HCT at our institution between June 2021 and June 2023. An initial evaluation of frailty was conducted at first consultation (pre-apheresis), followed by a subsequent evaluation at day +100.

Results

The median age was 58 years (range: 19–69), 41 (51.2 %) patients were males, 45 (56.3 %) were diagnosed with MM and 35 with LPD. At the initial consultation, 24 (30.0 %) adults were classified as fit, 48 (60.0 %) as pre-frail, and 8 (10.0 %) as frail. Frail patients were more likely to be older (OR 1.16 P = 0.077), and to have a KPS < 90 % (OR 27, P = 0.012), and also exhibit a higher number of comorbidities (HCT-CI>3: OR 11.9, p = 0.035). However, the underlying diagnosis did not impact the incidence of frailty at the initial consultation (OR 0.99, p = 0.999).

Conclusions

There was no association between the duration of at-home transplant hospitalisation and readmissions and the presence of frailty syndrome. Moreover, no patient died due to transplant-related toxicity. The results presented in this study support that at-home auto-HCT can be performed in fit, pre-frail, and frail adults with an experienced and multidisciplinary team. Although conclusions are limited by the reduced sample size, the observed differences on frailty incidences during patient's follow-up support that frailty is dynamic, and potentially amendable with specific interventions.

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成人恶性血液病的家庭自体造血细胞移植。在HCT过程中脆弱是如何影响和发展的。一项观察性、纵向和前瞻性研究

自2021年4月起，在我院接受auto-HCT的成人中，使用HCT虚弱量表对患者的虚弱状态进行常规评估。该量表将每个候选人分为健康、预健康或虚弱。我们的研究包括80名连续患有淋巴增生性疾病（LPD）和多发性骨髓瘤（MM）的成年人，于2021年6月至2023年6月在我们的机构接受了家庭auto-HCT。在第一次咨询时（采前）进行了虚弱的初步评估，随后在第100天进行了后续评估。结果中位年龄为58岁（范围：19-69岁），男性41例（51.2%），MM 45例（56.3%），LPD 35例。在最初的咨询中，24人（30.0%）被分类为健康，48人（60.0%）被分类为虚弱前期，8人（10.0%）被分类为虚弱。体弱的患者更可能年龄较大（OR 1.16 P = 0.077）， KPS <；90% (OR 27, P = 0.012)，并且还表现出更高的合并症（HCT-CI>3: OR 11.9, P = 0.035）。然而，在初次会诊时，基础诊断并不影响虚弱的发生率（OR 0.99, p = 0.999）。结论：家庭移植住院时间和再入院时间与虚弱综合征的存在无相关性。此外，没有患者死于移植相关的毒性。本研究的结果表明，在经验丰富的多学科团队的帮助下，家庭auto-HCT可以在健康、体弱和体弱的成年人中进行。虽然结论受到样本量减少的限制，但观察到的患者随访期间虚弱发生率的差异支持虚弱是动态的，并且可能通过特定的干预措施进行修正。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer treatment and research communications Medicine-Oncology

CiteScore

4.30

自引率

0.00%

发文量

148

审稿时长

56 days

期刊介绍： Cancer Treatment and Research Communications is an international peer-reviewed publication dedicated to providing comprehensive basic, translational, and clinical oncology research. The journal is devoted to articles on detection, diagnosis, prevention, policy, and treatment of cancer and provides a global forum for the nurturing and development of future generations of oncology scientists. Cancer Treatment and Research Communications publishes comprehensive reviews and original studies describing various aspects of basic through clinical research of all tumor types. The journal also accepts clinical studies in oncology, with an emphasis on prospective early phase clinical trials. Specific areas of interest include basic, translational, and clinical research and mechanistic approaches; cancer biology; molecular carcinogenesis; genetics and genomics; stem cell and developmental biology; immunology; molecular and cellular oncology; systems biology; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; cancer policy; and integration of various approaches. Our mission is to be the premier source of relevant information through promoting excellence in research and facilitating the timely translation of that science to health care and clinical practice.