Frailty and stem cell transplantation in the older patient with cancer

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.