DP103 | ASSESSMENT AND IMPACT OF FRAILTY IN OLDER ALLOGENEIC STEM CELL TRANSPLANT RECIPIENTS

RATIONALE Allogeneic stem cell transplantation (allo-SCT) can be offered to older patients, but clinical tools and biomarkers are needed to improve patient selection and reduce toxicity. The comprehensive geriatric assessment (CGA) may play a key role in assessing frailty and predicting treatment results. This single-center prospective study aimed to evaluate frailty and its impact on allo-SCT outcomes in patients ≥60 years. METHODS 44 consecutive patients aged ≥60 years with an indication for allo-SCT were included in the study from January 2022 to December 2024. Each patient underwent a pre-transplant CGA, conducted by an experienced geriatrician, with evaluation of functional autonomy, physical strength, nutritional and cognitive status, mood, perceived quality of life, and self-assessment of social support. Geriatricians and hematologists independently categorized each patient as fit, frail, or unfit, based on CGA and clinical evaluation respectively. RESULTS Median age at transplant was 65 years (range 60.2-71.5). The most frequent indication for allo-SCT was high risk acute myeloid leukemia or myelodysplastic syndrome (N=33, 75.0%). The donor was a matched sibling in 5 cases (11,4%), unrelated in 26 (59,1%) and haploidentical in 13 cases (29,5%). According to the Transplant Conditioning Intensity (TCI) score, conditioning regimen intensity was low in 21 patients (47.7%) and intermediate in 23 (52.3%). Median HCT-CI score was 2 (range 0-7): 17 patients (38.6%) had a score ≥ 3 points. The most represented comorbidities were reduced lung diffusion capacity (N=23, 52,3%) and heart disease (N=6, 13.6%). Geriatricians classified 19 patients (43.2%) as frail and 7 (15.9%) as unfit; hematologists classified 18 patients (40.9%) as frail, and no one as unfit. The most frequent pre-engraftment grade 3-4 toxicities were bloodstream infection (N=11), pneumonia (N=6), mucositis (N=6) and encephalopathy (N=5). Overall survival (OS) at 1 year post HSCT was 75.0% and 1-year cumulative incidence (CI) of non relapse mortality (NRM) was 25.0%. One-year OS and CI of NRM were superimposable in patients classified as fit by geriatricians and hematologists (OS 83.3% and 84.6%; NRM 16.7% and 15.3%, respectively); we observed a nonsignificant trend towards a better OS and a lower NRM for fit patients as compared to frail/unfit patients (Figure 1). CONCLUSIONS These preliminary results highlight the potential of CGA in optimizing care for elderly patients undergoing allo-HSCT.