https://orcid.org/0000-0003-0803-9607
Key Points
CHARM is an independent prognostic scoring system for geriatric morbidities after allogeneic HCT in patients ≥ 60 years of age.
CHARM scores are independently associated and informative of functional limitation-free survival through 1 year after allogeneic HCT.
Despite concerns about the toxicity of allogeneic hematopoietic cell transplantation (alloHCT) in older patients, prospective data are limited characterizing prevalence or risk-stratification for geriatric morbidity such as disability or frailty. We prospectively assessed the prognostic impact of the novel composite health assessment risk model (CHARM), a score established to predict 1-year non-relapse mortality (NRM), among 1105 patients aged ≥60 years enrolled on the Bone Marrow Transplant-Clinical Trials Network Study 1704. Secondary endpoints were assessed post-alloHCT at day (D) 100, 180 and 365 in multivariable models adjusted with predetermined clinical variables. Among alloHCT survivors, the prevalence of disability by instrumental activities of daily living (IADL), frailty by the Physical Frailty Phenotype and physical function impairment by PROMIS was highest at D100, and lower D180 and D365. Higher CHARM scores were independently associated with greater IADL disability [coefficient=-0.64, 95% confidence interval (CI): -0.85 to -0.43, p<0.001], increased frailty (coefficient=0.19, CI: 0.081 to 0.31, p<0.001), worse PROMIS physical function, greater PROMIS depression, increased serious organ toxicity by D100, more cognitive decline at D100, higher mortality after acute GVHD but not significantly associated with PROMIS anxiety or acute GVHD. Higher CHARM score predicted for worse disability-free survival (OR = 2.03, CI: 1.66 - 2.48, p<0.001) and lower frailty-free survival (OR =2.00, CI: 1.61 - 2.49). In summary, CHARM is an independent prognostic scoring system not only for NRM, but also for geriatric morbidity and functional limitation-free survival through 1-year after alloHCT. Pre-alloHCT CHARM is a novel tool to aid shared decision-making for older patients. NCT03992352
