Long-term Risk of Frailty in Survivors of Blood or Bone Marrow Transplantation

A study examined longitudinal trends in the frailty state of blood or bone marrow transplantation (BMT) survivors. The researchers found that over a roughly 13-year period, although most patients were not frail or prefrail at final follow-up, the presence of frailty doubled in this patient population.

“Placing these findings in the context of the higher risk of subsequent mortality among frail BMT survivors indicates an urgent need for early identification and intervention to mitigate adverse events,” the study authors wrote.

A total of 470 patients who underwent autologous and allogeneic BMT who survived at least two years post-transplantation filled out two questionnaires: one baseline questionnaire (t1), at a median 7.3 years following BMT, and a follow-up questionnaire (t2), which was done 13.2 years after t1. The primary outcome was change in frailty state (worsened, improved, and stable) between the two questionnaires. Patients were considered frail based on the presence of at least three of these characteristics: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness.

At t1, about a third of patients were aged at least 60 years; 50.6% of patients were male. The prevalence of frailty doubled from t1 (4.8%) to t2 (9.6%). A greater proportion of patients worsened than improved (18.8% vs. 9.7%). Factors associated with worsening were pre-BMT exposure to vincristine (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.3-3.39) and female sex (OR, 1.5; 95% CI, 0.93-2.4). Factors associated with frailty at t2 were pre-BMT exposure to vincristine (OR, 2.79; 95% CI, 1.44‐5.43), a history of chronic graft‐versus‐host disease (OR, 2.58; 95% CI, 1.2‐5.5), and grade 3 and 4 chronic health conditions at t1 (OR, 2.1; 95% CI, 1.08‐4.33).

The study was published in the March 1 issue of Cancer.

“In a cohort of patients followed longitudinally for a median of 20.6 years after BMT, with measurement of frailty state at 2 timepoints 13.2 years apart, we observed worsening in approximately 20% of the patients. The current results identify high‐risk subpopulations that could benefit from targeted interventions,” the researchers wrote in their conclusion.