HCT Frailty Scale may refine allo-HCT selection process

The HCT Frailty Scale (HCT-FS) is designed to be an informative measure of transplant outcomes in patients who are candidates to undergo allogeneic haematopoietic cell transplantation (HCT). The first assessment results were consistent across age groups and other baseline characteristics, suggesting that the scale is applicable to a wide range of patients in clinical practice.

“Although allogeneic HCT is a potentially curative option for patients with haematologic tumours, it comes with a substantial morbidity, mortality, and quality-of-life burden,” said Dr Maria Queralt Salas (Hospital Clinic de Barcelona, Spain). Her research group wondered whether the pre-transplant assessment should be refined. Traditionally, the eligibility for transplant is based on age and comorbidities. Dr Salas and colleagues designed a frailty scale and tested its prognostic value for overall survival (OS) and non-relapse mortality in adult patients who were candidates for allogeneic HCT (n=1,077) [1]. The HCT-FS includes measures such as the Clinical Frailty Scale, Timed Up and Go test, grip strength, serum albumin level, and falls in the last 6 months.

After the assessment, patients could be categorised as fit (n=360), pre-frail (n=579), or frail (n=138). Dr Salas mentioned that frail patients were not necessarily older than fit patients, but that they had a higher disease activity. Next to that, frail patients were significantly more likely to have fungal infections at 1 year of follow-up (10.9%) than pre-frail patients (4.6%) or fit patients (4.0%; P=0.004). “The cumulative incidence of ICU admission was also higher among frail patients [20.3%] than among pre-frail or fit patients [10.8%; 7.0%; P=0.002].” Furthermore, it was mentioned that the 2-year OS rates were 82%, 73%, and 62% in fit, pre-frail, and frail patients, respectively (P<0.001). Likewise, 2-year non-relapse mortality rates were lower in fit patients than in pre-frail or frail patients (12%, 20%, and 32%). “A multivariate analysis showed that the HCT-FS was an independent predictor for OS, with an increased risk of mortality in frail [HR 2.15; P<0.001] and pre-frail patients [HR 1.38; P=0.012], compared with fit patients,” Dr Salas pointed out. “This result was consistent across age groups and number of comorbidities, illustrating the utility of this assessment.”

In conclusion, the HCT-FS was an independent predictor of transplant outcomes in patients deemed eligible for allogeneic HCT, potentially refining the selection procedure for this burdensome treatment.

1. Queralt Salas M, et al. HCT frailty scale (HCT-FS) for assessing frailty in allogeneic hematopoietic cell transplant patients: results from a multicenter and prospective Canadian and Spanish initiative. LB4005, EHA2025 Congress, 12–15 June, Milan, Italy.

Medical writing support was provided by Robert van den Heuvel.
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Posted on 17 June 2025