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Photo credit: Chad McNeeley
Frailty among young adult hematopoietic cell transplant (HCT) survivors is high and approaches that of a community-based elderly population, according to results of the Bone Marrow Transplant Survivor Study.
Of the 998 HCT participants, frailty exceeded 8%, and they were 8.4 times more likely to be frail than their siblings.
Investigators defined frailty as exhibiting 3 or more of the following traits: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness.
Because HCT recipients are exposed to high-intensity chemotherapy, radiation, and immunosuppression at points before, during, and after transplant, the investigators set out to determine whether non-elderly HCT recipients who have survived 2 years or more after transplant were at a higher risk of frailty compared with a sibling comparator group.
Smita Bhatia, MD, of the University of Alabama at Birmingham, and colleagues conducted the study of HCT survivors between the ages of 18 and 64 and compared the results to a sibling control group. The authors also looked at the subsequent mortality of HCT survivors.
They reported their findings in JAMA Oncology.
The 998 HCT survivors who participated in the study received their transplants at City of Hope in Duarte, California, or at the University of Minnesota in Minneapolis, between 1974 and 1998. The survivors and the 297 siblings completed questionnaires between February 1999 and June 2005.
Demographics
The HCT survivors were a mean age of 42.5 years, and 911 (93%) had health insurance coverage.
This was comparable to the sibling controls, who were a mean age of 43.8 years (P=0.09) and 279 (95%) had health insurance coverage.
However, more siblings were female (64%), non-Hispanic white (88%), college graduates (56%), and 92% had annual household incomes of $20,000 or more.
In the HCT survivor group, 46% were female (P<0.001), 81% non-Hispanic white (P=0.004), 49% college graduates (P<0.001), and 80% had annual incomes of $20,000 or more (P<0.001).
HCT survivors were a mean age of 33.8 years when they had their transplants and the interval between HCT and participation in the study was 8.7 years.
Hematologic malignancies were the major diagnoses leading to HCT. Twenty-three percent had a primary diagnosis of chronic myeloid leukemia, 24% had acute myeloid leukemia, 19% had non-Hodgkin lymphoma, 10% had acute lymphoblastic leukemia, and 9% had Hodgkin lymphoma.
Seventy-seven percent of the HCT survivors had total body irradiation, and 300 of the 562 who received allogeneic transplants had chronic GVHD, with 24% of them reporting active GVHD at the time they participated in the study.
Frailty
Only 2 siblings (0.7%) considered themselves frail compared to 84 (8.4%) HCT survivors.
More survivors were underweight and reported low energy expenditure compared to the sibling group, but the differences were not statistically significant, P=0.26 and P=0.14, respectively.
However, significantly more survivors reported exhaustion (P<0.001), slowness (P<0.001), and weakness (P<0.001) compared to the sibling group,
The investigators then adjusted the data for age at study participation, sex, race/ethnicity, education, household income, health insurance, presence of grades 3 or 4 chronic health conditions, and transplant institution. They then found the HCT survivors to be 8.35 times more likely to be frail than their siblings (P=0.003).
HCT survivors with low annual incomes (P=0.03), less than a college education (P=0.002), with grades 3 or 4 chronic health conditions (P=0.02), with multiple myeloma (P=0.05), or with resolved chronic (P=0.04) or active chronic GVHD (P<0.001) were more likely to be frail compared to the other HCT survivors.
Mortality
The investigators followed the patients for a median of 10.3 years from the time participants completed the survey. At that time, 182 (18%) patients had died.
The 10-year cumulative all-cause mortality was 39.3% for patients with frailty and 14.7% for patients without frailty (P<0.001).
The 10-year cumulative relapse-related mortality was 15.5% among frail HCT patients and 4.5% for non-frail HCT patients.
And the 10-year cumulative non-relapse mortality was also higher among frail HCT recipients, 23.9% compared to 10.2% of the non-frail HCT recipients (P<0.001).
Multivariate analysis revealed that frailty was associated with a 2.76-fold increase in death. The variables included age at study participation, sex, presence of grades 3 to 4 chronic health conditions, primary diagnosis, annual household income, and risk of relapse at transplant.
The investigators concluded that the therapies transplant patients undergo and post-transplant complications constitute a substantial stressor, placing HCT survivors at risk for frailty and premature aging.
“These findings demonstrate the need for interventions,” they added, “including personalized assessments and multidisciplinary efforts targeting both pre-frail and frail individuals to improve outcomes.” 
for transplant
Photo credit: Chad McNeeley
Frailty among young adult hematopoietic cell transplant (HCT) survivors is high and approaches that of a community-based elderly population, according to results of the Bone Marrow Transplant Survivor Study.
Of the 998 HCT participants, frailty exceeded 8%, and they were 8.4 times more likely to be frail than their siblings.
Investigators defined frailty as exhibiting 3 or more of the following traits: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness.
Because HCT recipients are exposed to high-intensity chemotherapy, radiation, and immunosuppression at points before, during, and after transplant, the investigators set out to determine whether non-elderly HCT recipients who have survived 2 years or more after transplant were at a higher risk of frailty compared with a sibling comparator group.
Smita Bhatia, MD, of the University of Alabama at Birmingham, and colleagues conducted the study of HCT survivors between the ages of 18 and 64 and compared the results to a sibling control group. The authors also looked at the subsequent mortality of HCT survivors.
They reported their findings in JAMA Oncology.
The 998 HCT survivors who participated in the study received their transplants at City of Hope in Duarte, California, or at the University of Minnesota in Minneapolis, between 1974 and 1998. The survivors and the 297 siblings completed questionnaires between February 1999 and June 2005.
Demographics
The HCT survivors were a mean age of 42.5 years, and 911 (93%) had health insurance coverage.
This was comparable to the sibling controls, who were a mean age of 43.8 years (P=0.09) and 279 (95%) had health insurance coverage.
However, more siblings were female (64%), non-Hispanic white (88%), college graduates (56%), and 92% had annual household incomes of $20,000 or more.
In the HCT survivor group, 46% were female (P<0.001), 81% non-Hispanic white (P=0.004), 49% college graduates (P<0.001), and 80% had annual incomes of $20,000 or more (P<0.001).
HCT survivors were a mean age of 33.8 years when they had their transplants and the interval between HCT and participation in the study was 8.7 years.
Hematologic malignancies were the major diagnoses leading to HCT. Twenty-three percent had a primary diagnosis of chronic myeloid leukemia, 24% had acute myeloid leukemia, 19% had non-Hodgkin lymphoma, 10% had acute lymphoblastic leukemia, and 9% had Hodgkin lymphoma.
Seventy-seven percent of the HCT survivors had total body irradiation, and 300 of the 562 who received allogeneic transplants had chronic GVHD, with 24% of them reporting active GVHD at the time they participated in the study.
Frailty
Only 2 siblings (0.7%) considered themselves frail compared to 84 (8.4%) HCT survivors.
More survivors were underweight and reported low energy expenditure compared to the sibling group, but the differences were not statistically significant, P=0.26 and P=0.14, respectively.
However, significantly more survivors reported exhaustion (P<0.001), slowness (P<0.001), and weakness (P<0.001) compared to the sibling group,
The investigators then adjusted the data for age at study participation, sex, race/ethnicity, education, household income, health insurance, presence of grades 3 or 4 chronic health conditions, and transplant institution. They then found the HCT survivors to be 8.35 times more likely to be frail than their siblings (P=0.003).
HCT survivors with low annual incomes (P=0.03), less than a college education (P=0.002), with grades 3 or 4 chronic health conditions (P=0.02), with multiple myeloma (P=0.05), or with resolved chronic (P=0.04) or active chronic GVHD (P<0.001) were more likely to be frail compared to the other HCT survivors.
Mortality
The investigators followed the patients for a median of 10.3 years from the time participants completed the survey. At that time, 182 (18%) patients had died.
The 10-year cumulative all-cause mortality was 39.3% for patients with frailty and 14.7% for patients without frailty (P<0.001).
The 10-year cumulative relapse-related mortality was 15.5% among frail HCT patients and 4.5% for non-frail HCT patients.
And the 10-year cumulative non-relapse mortality was also higher among frail HCT recipients, 23.9% compared to 10.2% of the non-frail HCT recipients (P<0.001).
Multivariate analysis revealed that frailty was associated with a 2.76-fold increase in death. The variables included age at study participation, sex, presence of grades 3 to 4 chronic health conditions, primary diagnosis, annual household income, and risk of relapse at transplant.
The investigators concluded that the therapies transplant patients undergo and post-transplant complications constitute a substantial stressor, placing HCT survivors at risk for frailty and premature aging.
“These findings demonstrate the need for interventions,” they added, “including personalized assessments and multidisciplinary efforts targeting both pre-frail and frail individuals to improve outcomes.”
for transplant
Photo credit: Chad McNeeley
Frailty among young adult hematopoietic cell transplant (HCT) survivors is high and approaches that of a community-based elderly population, according to results of the Bone Marrow Transplant Survivor Study.
Of the 998 HCT participants, frailty exceeded 8%, and they were 8.4 times more likely to be frail than their siblings.
Investigators defined frailty as exhibiting 3 or more of the following traits: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness.
Because HCT recipients are exposed to high-intensity chemotherapy, radiation, and immunosuppression at points before, during, and after transplant, the investigators set out to determine whether non-elderly HCT recipients who have survived 2 years or more after transplant were at a higher risk of frailty compared with a sibling comparator group.
Smita Bhatia, MD, of the University of Alabama at Birmingham, and colleagues conducted the study of HCT survivors between the ages of 18 and 64 and compared the results to a sibling control group. The authors also looked at the subsequent mortality of HCT survivors.
They reported their findings in JAMA Oncology.
The 998 HCT survivors who participated in the study received their transplants at City of Hope in Duarte, California, or at the University of Minnesota in Minneapolis, between 1974 and 1998. The survivors and the 297 siblings completed questionnaires between February 1999 and June 2005.
Demographics
The HCT survivors were a mean age of 42.5 years, and 911 (93%) had health insurance coverage.
This was comparable to the sibling controls, who were a mean age of 43.8 years (P=0.09) and 279 (95%) had health insurance coverage.
However, more siblings were female (64%), non-Hispanic white (88%), college graduates (56%), and 92% had annual household incomes of $20,000 or more.
In the HCT survivor group, 46% were female (P<0.001), 81% non-Hispanic white (P=0.004), 49% college graduates (P<0.001), and 80% had annual incomes of $20,000 or more (P<0.001).
HCT survivors were a mean age of 33.8 years when they had their transplants and the interval between HCT and participation in the study was 8.7 years.
Hematologic malignancies were the major diagnoses leading to HCT. Twenty-three percent had a primary diagnosis of chronic myeloid leukemia, 24% had acute myeloid leukemia, 19% had non-Hodgkin lymphoma, 10% had acute lymphoblastic leukemia, and 9% had Hodgkin lymphoma.
Seventy-seven percent of the HCT survivors had total body irradiation, and 300 of the 562 who received allogeneic transplants had chronic GVHD, with 24% of them reporting active GVHD at the time they participated in the study.
Frailty
Only 2 siblings (0.7%) considered themselves frail compared to 84 (8.4%) HCT survivors.
More survivors were underweight and reported low energy expenditure compared to the sibling group, but the differences were not statistically significant, P=0.26 and P=0.14, respectively.
However, significantly more survivors reported exhaustion (P<0.001), slowness (P<0.001), and weakness (P<0.001) compared to the sibling group,
The investigators then adjusted the data for age at study participation, sex, race/ethnicity, education, household income, health insurance, presence of grades 3 or 4 chronic health conditions, and transplant institution. They then found the HCT survivors to be 8.35 times more likely to be frail than their siblings (P=0.003).
HCT survivors with low annual incomes (P=0.03), less than a college education (P=0.002), with grades 3 or 4 chronic health conditions (P=0.02), with multiple myeloma (P=0.05), or with resolved chronic (P=0.04) or active chronic GVHD (P<0.001) were more likely to be frail compared to the other HCT survivors.
Mortality
The investigators followed the patients for a median of 10.3 years from the time participants completed the survey. At that time, 182 (18%) patients had died.
The 10-year cumulative all-cause mortality was 39.3% for patients with frailty and 14.7% for patients without frailty (P<0.001).
The 10-year cumulative relapse-related mortality was 15.5% among frail HCT patients and 4.5% for non-frail HCT patients.
And the 10-year cumulative non-relapse mortality was also higher among frail HCT recipients, 23.9% compared to 10.2% of the non-frail HCT recipients (P<0.001).
Multivariate analysis revealed that frailty was associated with a 2.76-fold increase in death. The variables included age at study participation, sex, presence of grades 3 to 4 chronic health conditions, primary diagnosis, annual household income, and risk of relapse at transplant.
The investigators concluded that the therapies transplant patients undergo and post-transplant complications constitute a substantial stressor, placing HCT survivors at risk for frailty and premature aging.
“These findings demonstrate the need for interventions,” they added, “including personalized assessments and multidisciplinary efforts targeting both pre-frail and frail individuals to improve outcomes.”