Poor physical functioning is associated with adverse allogeneic hematopoietic cell transplant (alloHCT) outcomes. Analytic tools to predict alloHCT patient mortality include the HCT-comorbidity index (HCT-CI) based on comorbidities and the disease risk index (DRI) based on disease and disease status. We developed and replicated a risk model for overall survival (OS), early mortality (death due to any cause ≤Day 100), initial hospital length of stay (LOS), and percent of inpatient days within the first year.
We incorporated a physical therapy (PT) assessment with HCT-CI and DRI to improve outcome predictions.
A well-defined and feasible measure of functional status for assessing risk included: 1) the number of sit-to-stands in 30 seconds, 2) performance of 25 step-ups on the right/left side with 3) oxygen saturation recovery and 4) heart rate recovery, 5) weight bearing ability, 6) assistance with ambulation, 7) motor and grip strength, 8) sensory and coordination impairment (i.e. self-reported peripheral neuropathy, imbalance), 9) self-reported pain, and 10) limited endurance (unable to complete step-ups and/or sit-to-stands). A training cohort included 349 consecutive alloHCT patients at Roswell Park treated from 2010-2016 and a subsequent replication cohort (n=163) from 2016-2019. Four of the 10 metrics (1) self-reported pain, 2) limited endurance, 3) self-reported neuropathy, and 4) <10 sit-to-stands in 30 seconds) were significant predictors and included in the multivariable models with HCT-CI and DRI to create new risk indices (HCT-PCDRI: HCT-physical, comorbidity, and disease risk index) for outcomes. Models were tested in the replication cohort.
Shorter OS was associated with 1) self-reported pain, 2) limited endurance, 3) higher HCT-CI, and 4) higher DRI with a median follow-up of 34 months. The three-year OS based on the HCT-PCDRI was 30% for the very high, 54% for high, 49% for intermediate and 80% for low risk groups. Patients identified as very high risk increased from n=55 using HCT-CI alone to 120 with the new HCT-PCDRI; the low risk group decreased from n=91 to n=45, respectively. Early mortality and a higher percent of inpatient days within the first year post-alloHCT (proxy for poor quality of life and high healthcare utilization) were associated with 1) self-reported pain, 2) higher HCT-CI, and 3) higher DRI. A shorter initial LOS (initial low healthcare utilization) was associated with 1) >10 sit-to-stands in 30 seconds, 2) no self-reported neuropathy, and 3) lower HCT-CI. These PT metrics combined with the HCT-CI and DRI created the HCT-PCDRI, which resulted in more patients being categorized accurately as high vs low risk. The HCT-PCDRI replicated in an independent cohort.
Pre-alloHCT PT metrics with self-reported symptoms (pain and neuropathy) were associated with survival post-alloHCT and prolonged hospital stays. The HCT-PCDRI scoring system for alloHCT patient risk stratification more accurately identifies patients at potential risk of poor outcomes. The HCT-PCDRI can be tested in <15 minutes to identify patients for intervention prior to or during treatment to potentially improve outcomes.

Copyright © 2021. Published by Elsevier Inc.