Longitudinal trajectory of frailty in blood or marrow transplant survivors: Report from the Blood or Marrow Transplant Survivor study

Mukta Arora, Yanjun Chen, Jessica Wu, Lindsey Hageman, Emily Ness, Michelle Kung, Liton Francisco, Alysia Bosworth, Daniel J. Weisdorf, Stephen J. Forman, Wendy Landier, Merve Pamukçuoğlu, Saro H. Armenian, F. Lennie Wong, Smita Bhatia

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Blood or bone marrow transplantation (BMT) survivors with frailty are at a higher risk of subsequent mortality. Longitudinal trends in the frailty state are not known and could help identify vulnerable subpopulations at risk of subsequent adverse events. Methods: This study included a cohort of 470 autologous and allogeneic BMT recipients who had survived ≥2 years after BMT and completed a baseline questionnaire (t1) at a median of 7.3 years after BMT and a follow-up questionnaire (t2) 13.2 years after t1. The main outcome was change in frailty state between t1 and t2. Frailty phenotype was defined as exhibiting ≥3 of the following characteristics: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness. The following categories of change in frailty state were evaluated: worsened, improved, and stable. Results: Of the 470 participants, 36.4% were aged ≥60 years at t1, and 50.6% were men. The prevalence of frailty increased from 4.8% at t1 to 9.6% at t2. Worsening was observed in 18.8% of patients, and improvement was reported in 9.7%. Pre-BMT exposure to vincristine (odds ratio [OR], 2.1; 95% CI, 1.3-3.39) was associated with worsening. Female sex (OR, 1.5; 95% CI, 0.93-2.4) was associated with a trend toward worsening. 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) were associated with frailty at t2. Conclusions: In a cohort of BMT survivors who were followed longitudinally for a median of 20.6 years from BMT, the frailty status worsened for approximately20% over a 13-year timespan. BMT survivors who are at risk for worsening frailty could benefit from targeted interventions.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
This study was supported by grants from the National Cancer Institute (R01 CA078938), and the Leukemia and Lymphoma Society (R6502‐16 to Smita Bhatia).

Keywords

  • cohort study
  • frailty
  • hematopoietic stem cell transplantation
  • long-term survivors
  • longitudinal trajectory

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