Sara Villar

Objectives: To evaluate whether Hematopoietic Cell Transplantation Frailty Scale (HCT‐FS)‐defined frailty predicts overall survival (OS), nonrelapse mortality (NRM), and relapse across diverse hematologic diagnoses undergoing allogeneic hematopoietic cell transplantation (alloHCT), including nonmalignant disorders. Methods: We conducted a multicenter retrospective cohort study of 992 adults undergoing alloHCT at 16 centers in Canada and Spain (2018–2023). Frailty was assessed at consultation using the HCT‐FS (fit, prefrail, frail). OS was estimated by Kaplan–Meier, competing‐risks methods by cumulative incidence. Multivariable models assessed associations with OS and NRM. Results: Frailty was assessed across six diagnostic categories, including nonmalignant disorders (4.8%). At consultation, 32.1% were fit, 54.7% prefrail, and 13.2% frail. Increasing frailty was associated with progressively lower 2‐year OS (78.9%, 66.0%, 51.7%; p < 0.001) and higher 2‐year NRM (10.5%, 18.9%, 33.2%; p < 0.001; HR 1.77 [95% CI 1.21–2.60] prefrail and 3.65 [2.36–5.65] frail vs. fit), while 2‐year relapse incidence did not differ (19.0%, 23.5%, 22.3%; p = 0.229). Disease‐specific estimates were exploratory and limited by small subgroup sizes. Conclusions: HCT‐FS‐defined frailty is associated with OS and NRM but not relapse in this multicenter alloHCT cohort. Larger disease‐specific studies are needed to establish its prognostic value in less represented indications.

Summary: This prospective study evaluated the incidence and dynamics of frailty in 156 adults with lymphoproliferative syndromes undergoing autologous haematopoietic stem cell transplantation (HSCT). Frailty was assessed using the haematopoietic cell transplantation (HCT) frailty scale in patients from 15 Spanish institutions at initial consultation, transplant admission and day +100. Quality of life (QoL) was measured using the EuroQoL. At first consultation, 45 patients (28.8%) were classified as fit, 93 (59.6%) as pre‐frail and 18 (11.6%) as frail. Frailty was more frequent among older patients, those with Karnofsky performance status (KPS) below 90%, and abnormal Mini‐Cog scores (p = 0.19). At day +100, 33.6% of patients were fit, 57.9% pre‐frail and 8.5% frail, demonstrating significant transitions in frailty over time ( p = 0.001). Moreover, frail patients showed lower relapse‐free [53.3% (17.7–79.6) vs. 85.3% (68.3–93.6), p = 0.05] and overall survival [77.8% (36.5–93.9) vs. 100%, p = 0.16], and worse perceived QoL than fit ones. Overall, frailty was dynamic and clinically relevant, supporting routine assessment and targeted interventions to mitigate adverse outcomes.

Bispecific antibodies directed against BCMA and GPRC5D have shown remarkable efficacy in patients with refractory multiple myeloma; however, concerns regarding infection risk are emerging. In a cohort of 85 treated patients, we observed a notable incidence of Campylobacter infections, including 5 bloodstream and 5 gastrointestinal episodes, affecting 9 individuals. This unexpectedly high burden of infection highlights the vulnerability of this immunocompromised population and underscores the urgent need for studies evaluating targeted preventive and surveillance strategies.

Background: Post-transplant cyclophosphamide (PTCy) is a standard graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic cell transplantation (allo-HCT). While effective, concerns remain about cyclophosphamide-related cardiotoxicity, especially in patients with pre-existing cardiac morbidity, a population often underrepresented in clinical trials. Objectives: To assess the incidence and outcomes of early (ECE, ≤100 days) and late (LCE, >100 days) cardiac events in acute myeloid leukemia (AML) patients with and without baseline cardiac morbidity undergoing allo-HCT with PTCy. Study Design: Retrospective multicenter study by the Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) including 461 AML patients (62 with cardiac morbidity) transplanted between 2012 and 2022. Cardiac morbidity was defined by documented cardiac disease or left ventricular ejection fraction < 45%. Cumulative incidence, overall survival (OS), and non-relapse mortality (NRM) were analyzed using competing risks models and adjusted with propensity score matching (PSM) and inverse probability weighting (IPW). Results: Cardiac events occurred in 13.2% of patients: 11% vs. 7% ECE (p = 0.93) and 8% vs. 5.3% LCE (p = 0.85) in those with vs. without cardiac morbidity. Most ECEs were arrhythmias or heart failure. Adjusted analyses confirmed no significant differences in CE incidence, OS, or NRM between groups. Two-year OS was 69% vs. 70% (p = 0.50); NRM was 18% vs. 17% (p = 0.20). ECE was associated with higher mortality in both groups. Conclusions: PTCy is feasible in AML patients with pre-existing cardiac morbidity when combined with comprehensive cardiovascular evaluation and cardio-oncology follow-up, supporting its safe use in broader patient populations with appropriate cardiologic support.

INTRODUCTION: This collaborative study aims to present the results obtained from the implementation of the Hematopoietic Cell Transplantation Frailty Scale (HCT-FS) for the assessment of frailty in adult candidates for allogeneic hematopoietic cell transplantation (allo-HCT) at 16 independent HCT Units.METHODS: Sixteen allo-HCT programs (1 in Canada, 15 in Spain) participated. Frailty was systematically assessed at the first allo-HCT consultation using the HCT-FS (https://hctfrailtyscale.com) and incorporated into routine clinical practice at each center without external funding.RESULTS: A total of 1,077 consecutive adult allo-HCT candidates (median age: 56 years) were evaluated. Based on the HCT-FS, 33.4% were classified as fit, 53.7% as pre-frail, and 12.8% as frail. Frailty was associated with longer hospital stays during allo-HCT (28 days vs. 23 and 25; P = 0.003) and higher ICU admission rates by day + 180 (20.3% vs. 7.0% and 10.8%; P = 0.002). Two-year OS decreased progressively with increasing frailty: 77.2% in fit, 65.7% in pre-frail, and 52.8% in frail patients (P < 0.001). Corresponding non-relapse mortality (NRM) rates were 11.7%, 19.5%, and 32.2%, respectively (P = 0.001). Multivariable analysis confirmed frailty as an independent predictor of inferior OS and increased NRM, even when adjusting for age, comorbidities, performance status, disease risk, and donor type.The HCT-FS maintained robust prognostic accuracy across subgroups stratified by age and comorbidity burden, supporting its broad applicability in clinical practice regardless of patients’ baseline characteristics.CONCLUSION: The HCT-FS provides reliable measures of the frailty status of allo-HCT candidates that are informative in anticipating transplant outcomes, particularly risk of OS. Its use is recommended in clinical practice for pre-transplant assessments.

This study evaluated the impact of donor age on clinical outcomes in 274 patients with acute myeloid leukemia (AML) haplo-HCT using PTCY-based prophylaxis. Median patient age was 53 years, with 42.6% classified as high-risk AML. The median donor age of 38 years; 31% were under 30. An optimal donor age cut-off of 30 years was identified through ROC analysis. Patients receiving grafts from younger donors (<30 years) showed lower rates of aGVHD grade II–IV (3.0% vs. 19.9%, p < 0.001) and grade III–IV (1.5% vs. 10.2%, p = 0.034), with no differences in cGVHD or relapse rates. Overall survival (OS) was higher in the younger donor group (2-year: 80.6% vs. 64.3%, p = 0.011), along by lower non-relapse mortality (NRM) (2-year: 11.1% vs. 23.2%, p = 0.031). Multivariate analysis confirmed donor age ≥30 years as an independent adverse factor for OS (HR: 1.88, p = 0.019) and NRM (HR: 2.06, p = 0.049), along with older recipient age, higher HCT-CI score, and high-risk AML. These findings suggest that younger donor age contributes to improved survival, primarily through reduced NRM and aGVHD, supporting prioritization of younger donors when multiple haploidentical options are available to optimize transplant outcomes.