Transplant Cell Ther. 2023 Aug 27:S2666-6367(23)01505-1. doi: 10.1016/j.jtct.2023.08.023. Online ahead of print.
ABSTRACT
BACKGROUND: Clinical research regarding the impact of pretransplant physical function on transplantation outcomes in older adults is still limited.
METHODS: We retrospectively reviewed the charts of 150 consecutive patients over 55 years of age who underwent their first allogeneic hematopoietic cell transplantation (HCT) at our center between 2010 and 2021. We evaluated the clinical impact of pretransplant physical function, including hand grip strength (HGS), knee extension strength (KES), and distance covered in a six-minute walk test (6MWT), along with other clinical factors on transplantation outcomes such as overall survival (OS), non-relapse mortality (NRM) and cumulative incidence of disease relapse (CIR).
RESULTS: There were no differences in OS, NRM, or CIR among the age groups (56-60, 61-65 and 66-70 years). With regard to physical function tests, we divided the study patients into two groups using the median values of HGS, KES and 6MWT (higher and lower groups). Since there were significant differences in HGS and KES between male and female patients, sex-specific threshold values were used. In a univariate analysis, OS tended to be better in the higher-physical function group than in the lower-physical function group (4-year OS, 42.0% vs. 32.0% in HGS, P = 0.14; 44.8% vs. 37.8% in KES, P = 0.17; 46.7% vs. 30.5% in 6MWT, P = 0.099). NRM was significantly lower in the higher-physical function group than in the lower-physical function group (4-year NRM, 25.5% vs. 39.9% in HGS, P = 0.045; 17.7% vs. 38.0% in KES, P = 0.005; 22.5% vs. 43.4% in 6MWT, P = 0.033). There was no significant difference in CIR between the higher- and lower- physical function groups (The 4-year CIR, 34.6% vs. 28.7% in HGS, P = 0.38; 38.5% vs 25.8% in KES, P = 0.20; 33.0% vs 27.0% in 6MWT, P = 0.42). In a multivariate analysis, the higher-KES group (hazard ratio [HR] 0.54 (95% confidence interval [CI], 0.32 – 0.90)) was significantly associated with better OS along with female sex (HR 0.48 [95%CI, 0.26 – 0.89]) and low / intermediate disease risk index (HR 3.59 [95%CI, 2.04 – 6.31]), and higher-KES (HR 0.37 [95%CI, 0.17 – 0.83]) and female sex (HR 0.36 [95%CI, 0.13 – 0.998]) were significantly associated with a reduced risk of NRM. The higher-HGS and higher-6MWT groups tended to be associated with a reduced risk of NRM, but this trend was not statistically significant.
CONCLUSIONS: Pretransplant physical function, particularly the strength of the lower extremities, rather than chronological age is associated with NRM and OS after allogeneic HCT in adults over 55 years of age.
PMID:37643718 | DOI:10.1016/j.jtct.2023.08.023
