Abstract
Age, performance status, and single organ comorbidities have been typically used to
assess the suitability of patients for stem cell transplantation (SCT). Until recently,
these criteria, combined with poor outcomes, have excluded many older patients from
SCT. Improvements in supportive care, reduced-intensity conditioning regimens, and
more tolerable graft-versus-host disease (GVHD) prophylaxis have increased the number
of older individuals now considered to be viable candidates for SCT. However, this
raises concerns about the tolerability of SCT for older persons. Many SCT recipients
present with fatigue, weakness, dyspnea, sleep disturbance, and anorexia in the post
transplant period, symptoms consistent with a frailty syndrome. These observations,
plus the fact that SCT is increasingly offered to older patients, suggest the need
to use assessment tools that are appropriate for this population and able to assess
frailty. Comprehensive geriatric assessment (CGA) needs to be tailored specifically
to the SCT patient. CGA may prove useful in identifying and risk stratifying those
older SCT recipients most likely to become frail following transplantation. Such insight
would allow the early use of pharmacologic and rehabilitative interventions that could
be targeted to help minimize the toxicity associated with SCT. Frailty caused by SCT
may also provide a model of accelerated frailty due to aging, as many similarities
may exist in the two syndromes.
Keywords
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Article info
Publication history
Published online: April 27, 2012
Accepted:
March 23,
2012
Received in revised form:
February 13,
2012
Received:
October 24,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
