Physiologic Frailty in Nonelderly Hematopoietic Cell Transplantation Patients Results From the Bone Marrow Transplant Survivor Study
Physiologic Frailty in Nonelderly Hematopoietic Cell Transplantation Patients Results From the Bone Marrow Transplant Survivor Study
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DOI：
10.1001/jamaoncol.2016.0855
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发表时间：
2016-10-01
期刊：
影响因子：
28.4
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Arora, Mukta;Sun, Can-Lan;Bhatia, Smita
重要性 虚弱会导致生理储备下降和对压力源的抵抗力下降；大约 10% 的老年人（>= 65 岁）身体虚弱。造血细胞移植 (HCT) 后的高强度治疗和并发症会损伤正常组织，甚至可能增加非老年 HCT 患者虚弱的风险。 目的 确定年轻成人 HCT 患者（18 至 64 岁）及其兄弟姐妹虚弱的患病率；设计、环境和参与者 这项队列研究于 2015 年 8 月进行，研究了 998 名 HCT 幸存者和 297 名频率匹配的兄弟姐妹，这些幸存者在 1974 年至 1998 年间接受了移植手术，他们在 HCT 后存活了至少 2 年。该研究在希望之城或明尼苏达大学进行，参与者在家中或诊所完成调查。参与骨髓移植幸存者研究（BMTSS）的造血细胞移植幸存者和兄弟姐妹在1999年2月13日至2005年6月15日期间完成了衰弱调查（自HCT以来的中位时间：7.9年）；对 HCT 幸存者随后的死亡率进行随访（中位值：调查后 10.3 年）。 主要结果和措施 衰弱的患病率和预测因素；虚弱对 HCT 幸存者随后死亡率的影响。虚弱表型定义为表现出以下 3 种或更多特征：临床体重过轻、疲惫、能量消耗低、行走速度慢和肌肉无力。截至 2011 年 12 月 21 日，使用国家死亡指数、社会保障死亡指数和医疗记录进行死亡率评估。 结果 998 名 HCT 幸存者的平均年龄 (SD) 为 42.5 (11.6) 岁，297 名匹配的兄弟姐妹年龄为 43.8 (10.9) 岁。年轻成人 HCT 患者虚弱患病率超过 8%。 HCT 幸存者虚弱的可能性是其兄弟姐妹的 8.4 倍（95% CI，2.0-34.5；P = .003）。在 HCT 受者中，与自体 HCT 相比，患有慢性移植物抗宿主病 (GvHD) 的同种异体 HCT 受者虚弱的风险增加（OR，15.02；95% CI，6.6-34.3；P < 0.001）；慢性 GvHD 得到解决（OR，2.7；95% CI，1.1-6.9；P = 0.04）。对于有体弱和无体弱的 HCT 接受者，10 年时随后全因死亡率的累积发生率分别为 39.3% 和 14.7% (P < .001)。调整相关预测因素后，虚弱与后续死亡风险增加 2.76 倍（95% CI，1.7-4.4；P < .001）相关。 结论和相关性 年轻成人 HCT 幸存者中虚弱的患病率与老年人群中的虚弱患病率相似。与非虚弱的幸存者相比，虚弱的 HCT 幸存者随后死亡的风险更高。这项研究确定了需要密切监测的弱势群体，以预测和管理发病率并预防死亡。
IMPORTANCE Frailty results in decreased physiological reserve and diminished resistance to stressors; approximately 10% of those in the elderly population (those >= 65 years) are frail. High-intensity treatments and complications after hematopoietic cell transplantation (HCT) injure normal tissues and may increase the risk of frailty even among nongeriatric HCT patients.OBJECTIVE To determine the prevalence of frailty in young adult HCT patients (18- to 64-year-olds) and siblings; and the impact of frailty on subsequent mortality in HCT survivors.DESIGN, SETTING, AND PARTICIPANTS This cohort study, conducted in August 2015 examined 998 HCT survivors, who underwent transplant procedures between 1974 and 1998, who have survived at least 2 years after HCT, and 297 frequency-matched siblings. The study was performed at City of Hope or University of Minnesota with participants completing surveys at home or in the clinic. Hematopoietic cell transplantation survivors and siblings participating in the Bone Marrow Transplant Survivor Study (BMTSS) completed a frailty survey between February 13, 1999, and June 15, 2005 (median time since HCT: 7.9 years); HCT survivors were followed for subsequent mortality (median: 10.3 years from survey).MAIN OUTCOMES AND MEASURES Prevalence and predictors of frailty; impact of frailty on subsequent mortality in HCT survivors. Frailty phenotype defined as exhibiting 3 or more of the following characteristics: clinically underweight, exhaustion, low energy expenditure, slow walking speed, and muscle weakness. The national Death Index, Social Security Death Index and medical records were used for mortality assessment as of December 21, 2011.RESULTS The 998 HCT survivors were a mean (SD) of 42.5 (11.6) years of age, and the 297 matched siblings were 43.8 (10.9) years of age. The prevalence of frailty among young adult HCT patients exceeded 8%. The HCT survivors were 8.4 times more likely to be frail than their siblings (95% CI, 2.0-34.5; P = .003). Among HCT recipients, allogeneic HCT recipients with chronic graft-vs-host disease (GvHD) were at increased risk of frailty compared with autologous HCT (OR, 15.02; 95% CI, 6.6-34.3; P < .001); resolved chronic GvHD (OR, 2.7; 95% CI, 1.1-6.9; P = .04). Cumulative incidence of subsequent all-cause mortality was 39.3% and 14.7% at 10 years for HCT recipients with and without frailty, respectively (P < .001). Frailty was associated with a 2.76-fold (95% CI, 1.7-4.4; P < .001) increased risk of subsequent mortality after adjusting for relevant prognosticators.CONCLUSIONS AND RELEVANCE The prevalence of frailty among young-adult HCT survivors approaches that seen in the elderly general population. Frail HCT survivors are at increased risk of subsequent mortality when compared with nonfrail survivors. This study identifies vulnerable populations needing close monitoring to anticipate and manage morbidity and prevent mortality.