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Frailty assessment and outpatient pre-habilitation for adults undergoing allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 60, pages 841–850 (2025)Cite this article

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Abstract

This study reports the preliminary results of a Frailty program involving all allo-HCT candidates, initiated at our institution in April 2021. The program started with the assessment of patients’ frailty at first consultation and at transplant admission using the HCT Frailty Scale. After observing the dynamics of the frailty syndrome, in June 2022 the program incorporated an individualized 4-8-weeks pre-habilitation program composed by personalized home-based exercise regimens to mitigate or prevent patients’ frailty at transplantation. This study includes the 120 patients transplanted during the program, 58 of them participating in the pre-habilitation program. The results indicate that the distribution of frailty was the same in first consultation and at HCT admission in non-pre-habilitated patients, but it changed from the proportions of fit, pre-frail and frail patients of 22.8%, 66.7%, 10.5% at first consultation, to the proportions 45.6%, 50.9% and 3.5% (P = 0.041) at admission in the pre-habilitated ones. And that the likelihood of OS was lower in the frail than in the fit and the pre-frail groups (1-year OS: 45.7% vs. 77.2%, O = 0.021). Therefore, the study provides preliminary evidence that pre habilitation programs significantly reduces frailty among transplant candidates and, eventually, increase the likelihood of OS.

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Fig. 1
Fig. 2: HCT frailty scale classification and impact of pre-habilitation on frailty stages.
Fig. 3: Frailty syndrome at HCT admission and main outcomes after Allo-HCT.

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Acknowledgements

We thank our patients and the nursing and medical staff at Hospital Clínic de Barcelona. The principal investigator is extremely grateful to Dr. Rajat Kumar and Dr. Shabbir Alibhai for their support during the study period.

Author information

Authors and Affiliations

  1. Hematopoietic Transplantation Unit, Hematology Department, Institute of Cancer and Blood Diseases (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain

    María Queralt Salas, Laia Guardia, María Teresa Solano, Cristina Moreno, Noemi de Llobet, Cristina Gallego, Jordi Esteve, María Suárez-Lledó, Laura Rosiñol, Carmen Martínez, Francesc Fernández-Avilés & Montserrat Rovira

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    María Queralt Salas, Paola Charr, Joan Cid, Miquel Lozano, Julia Martínez-Sanchez, Maribel Díaz-Ricart, Jordi Esteve, María Suárez-Lledó, Laura Rosiñol, Carmen Martínez, Francesc Fernández-Avilés & Montserrat Rovira

  3. Universitat de Barcelona, Barcelona, Spain

    María Queralt Salas, Raquel Salinas-González, Cristina Padilla, Paola Charr, Joan Cid, Miquel Lozano, Julia Martínez-Sanchez, Maribel Díaz-Ricart, Jordi Esteve, María Suárez-Lledó, Laura Rosiñol, Sara Laxe, Concepción Closa, Carmen Martínez, Francesc Fernández-Avilés & Montserrat Rovira

  4. Physical Medicine and Rehabilitation Department. Hospital Clínic de Barcelona, Barcelona, Spain

    Raquel Salinas-González & Sara Laxe

  5. Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Institute of Cancer and Blood Diseases (ICAMS), Hospital Clínic de Barcelona, Barcelona, Barcelona, Spain

    Paola Charr, Joan Cid & Miquel Lozano

  6. Endocrinology and Nutrition Department, Institute of digestive and metabolic diseases (ICMDM), Hospital Clínic de Barcelona, Barcelona, Spain

    Carla Mestre

  7. Cardiology Department. Hospital Clínic de Barcelona, Barcelona, Spain

    Enric Cascos

  8. Clinical Psychologist. Health Clinical Psychology Unit, Department of Psychiatry and Psychology, Clinical Institute of Neurosciences (ICN), Hospital Clínic de Barcelona, Barcelona, Spain

    Bernat Carreras & Vanessa Vilas

  9. Social Worker. Hematology Department, Institute of Cancer and Blood Diseases (ICAMS), Hospital Clínic de Barcelona, Barcelona, Spain

    Montserrat Duch

  10. Hemostasis and Erythropathology Laboratory, Hematopathology, Department of Pathology, Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Barcelona, Spain

    Julia Martínez-Sanchez & Maribel Díaz-Ricart

  11. Fundació i Institut de Reserca Josep Carreras Contra la Leucèmia, Barcelona, Spain

    Enric Carreras

  12. WHOFIC Academic CC Hospital Clínic-Universitat de Barcelona, Barcelona, España

    Sara Laxe

Authors
  1. María Queralt Salas
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  2. Raquel Salinas-González
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Contributions

MQS designed the study, collected the data, performed statistical analysis, and wrote the paper. All the staff members and nursing team of the HCT Unit and the Rehabilitation Service at the Hospital Clínic de Barcelona have supported the implementation of this program into our clinical practice, and provided a valuable input into the present study. RS, CP, SL, CM, and CC carry out the pre-habilitation program. LG, MTS, CM, NDL, and CG perform the frailty evaluation of patients with the HCT Frailty Scale. RS, LG, MTS, CP, CM, PC, NDL, CM, EC, JC, ML, CG, SL, BC, VS, JM, MDR, JE, EC, MSL, LR, CC, CM, FFA, and MR contributed significantly to the study, offering valuable feedback, and critically reviewing and approving the manuscript.

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Correspondence to María Queralt Salas.

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Salas, M.Q., Salinas-González, R., Guardia, L. et al. Frailty assessment and outpatient pre-habilitation for adults undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 60, 841–850 (2025). https://doi.org/10.1038/s41409-025-02571-9

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