Frailty in older patients who undergo stem cell transplantation
Background: Increasing numbers of older persons undergo stem cell transplantation (SCT) as the only chance of meaningful survival for hematologic malignancies, but the durable benefit of SCT may be compromised by the development of frailty in vulnerable elders. In this pilot study, we assessed older patients for factors predisposing them to toxicity to identify patients undergoing SCT who develop a persistent frailty syndrome after SCT. Methods: We enrolled 50 patients 60 years and older at MD Anderson Cancer Center between June 2010 and August 2012. Patients completed a baseline comprehensive geriatric assessment (CGA) which included tools to identify deficits in comorbidity, polypharmacy, nutritional status, physical performance, functional status, social support, depression and anxiety, and cognition. Frailty was defined as having 3 or more abnormalities of grip strength, gait speed, weight loss, physical activity, and exhaustion, and was assessed at baseline and at 3- and 6-month follow up visits. Associations between frailty and abnormal CGA (defined as 2 or more abnormal domains) as well as baseline patient characteristics were determined using Chi square tests or Fisher's exact tests for categorial variables and the Wilcoxon rank sum test for continuous variables. Results: Of 134 patients approached, 50 (37.7%) enrolled. Most patients were 60-64 years, white, male, married, and employed. Only 24 (48%) completed all three assessments. Frailty at baseline was present in 11 (22%) patients, and abnormal CGA was present in 33 (66%). Of the 24 who completed the study, 9 were frail at 3 months and 13 were frail at 6 months. Abnormal CGA was not associated with frailty at baseline, 3, or 6 months, or with the ability to complete the study. Conclusion: A substantial proportion of older patients undergoing SCT were frail and had abnormal CGA prior to treatment. However, CGA was not associated with the development of frailty. Future studies of the impact of SCT in older patients should focus on the treatable deficits identified by CGA to determine whether interventions aimed at such deficits could improve function and quality of life.
Holmes, Holly M, "Frailty in older patients who undergo stem cell transplantation" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1566327.