Journal: Blood advances
This study reports on a structured frailty and prehabilitation program for allogeneic HCT candidates at a single institution over three sequential phases (total n=185, 2021–2025):
- • Phase 1 – No-Prehab (n=76): Frailty assessment only using the HCT Frailty Scale at consult and at HCT admission.
- • Phase 2 – Pilot-Prehab (n=59): Home-based, nonsupervised exercise prehabilitation, median duration 6 weeks.
- • Phase 3 – Tele-Prehab (n=50): A structured, digitally delivered telemedicine prehabilitation program supervised by rehabilitation physicians (HCT Pre-App Program), also over a median of 6 weeks.
Key findings:
- • Adherence: High across all frailty categories (76–88%) with no reported adverse events.
- • Change in frailty status:
- • Pilot-Prehab: Proportion of “fit” patients increased from 22% at initial consult to 42% at admission (P = .009).
- • Tele-Prehab: “Fit” patients increased from 34% to 56% (P = .001).
- • Independent effects of Tele-Prehab:
- • Increased odds of being fit at admission (OR 3.86; P = .001).
- • Reduced incidence of frailty (OR 0.17; P = .031).
- • Survival outcomes (1-year):
- • Overall survival similar across cohorts: 74.5%, 84.5%, and 78.1% (P = .367).
- • Non-relapse mortality showed a nonsignificant trend toward reduction with prehabilitation: 14.6%, 5.1%, and 5.6% (P = .075).
Clinical implications:
Frailty in allo-HCT candidates appears modifiable over a short pre-transplant window. A home-based, digitally supervised prehabilitation model is feasible, safe, and significantly improves pre-transplant fitness, with a suggestion—but not definitive proof—of reduced non-relapse mortality.