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787 Transforming Frailty Care in Allo-HCT Candidates: A Prospective Assessment of a Tele-Prehabilitation Project

Program: Oral and Poster Abstracts
Type: Oral
Session: 903. Health Services and Quality Improvement: Myeloid Malignancies: Innovative Approaches to Improve Quality of Care, Affordability, and Outcomes
Hematology Disease Topics & Pathways:
Research, Clinical Practice (Health Services and Quality), Clinical Research, Health outcomes research, Adverse Events, Survivorship
Monday, December 9, 2024: 10:30 AM

Maria Queralt Salas, MD1*, Raquel Salinas González, MD2*, Carla Mestre3*, Laia Guardia4*, Cristina Moreno5*, Berta Sole6*, Filipe Pinto, MD4*, Paola Charry, MD7*, Joan Cid, MD PhD8*, Miquel Lozano, MD, PhD9*, Enric Cascos, MD10*, Julia Martinez-Sanchez, PhD11*, Maribel Diaz-Ricart, PhD11*, Raquel Sebio2*, Sara Laxe, MD12*, Enric Carreras, MD, PhD13*, Jordi Esteve, MD, PhD14, Maria Suarez-Lledo, MD, PhD15*, Laura Rosiñol Dachs, MD PhD16*, Concepción Closa, MD12*, Maria Carmen Martinez Munoz, MD, PhD5*, Francesc Fernández-Avilés, MD, PhD17* and Montserrat Rovira, MD, PhD17*

1Hematopoietic Transplantation Unit, Hospital Clinic de Barcelona, ICAMS, Barcelona, Spain
2Physical Medicine and Rehabilitation Department, Hospital Clinic de Barcelona, Barcelona, Spain
3Endocrinology and Nutrition Department, Hospital Clinic of Barcelona, Barcelona, Spain
4Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clinic de Barcelona, Barcelona, Spain
5Hematopoietic Cell Transplant Unit, Hospital Clinic of Barcelona, ICAMS, Barcelona, Spain
6Hematopoietic Cell Transplant Unit, Hospital Clinic de Barcelona, ICAMS, Barcelona, Spain
7Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clinic de Barcelona, Barcelona, Spain
8Hospital Clinic, University of Barcelona, Barcelona, Spain
9Apheresis and Cellular Therapy Unit, Hemotherapy and Hemostasis Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
10Cardiology Department, Hospital Clinic de Barcelona, Barcelona, Spain
11Hemostasis and Erythropathology, Hematopathology, Pathology Department, CDB, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
12Physical Medicine and Rehabilitation Department, Hospital Clinic of Barcelona, Barcelona, Spain
13Fundació Josep Carreras Contra la Leucèmia, Barcelona, Spain
14Hematology Department, Hospital Clínic Barcelona, ICAMS, Barcelona, Spain
15Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Spain, Hospital Clínic de Barcelona, Barcelona, Spain
16Hematopoietic Cell Transplant Unit, Hospital Clínic de Barcelona, ICAMS, Barcelona, Spain
17Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain

Introduction

Frailty increases the risk of mortality and morbidity in allo-HCT patients. Therefore, the assessment for prevention and improving of frailty in allo-HCT candidates should improve transplant outcomes. With this premise, a Frailty Program for adult allo-HCT candidates has been developed at our institution. Starting in April 2021, all candidates were assessed for frailty using the HCT Frailty Scale at their first allo-HCT consultation and again at HCT admission. In June 2022, a pilot outpatient pre-habilitation (pre-hab) program (PreHabP) focusing on physical activity was launched. Enhancements were made in November 2023, incorporating a telematic physiotherapy app and pretransplant nutritional support.

This analysis prospectively evaluates the preliminary outcomes of the innovative outpatient pre-hab program supervised through telemedicine (T-PreHab) for adult allo-HCT candidates implemented at our institution.

Methods

Since November 2023, all allo-HCT candidates were included in the T-PreHab. A median of 7 days after the first allo-HCT consultation, a PM&R physician assesses and prescribes an individualized home-based exercise program tailored to the patient's frailty status (according to the HCT Frailty Scale) and medical history. A nutritional consultation provides personalized recommendations and protein supplements if needed. The T-PreHab is delivered via a dedicated app with comprehensive video instructions to enhance understanding and adherence. This program includes a minimum of 3 asynchronous e-training sessions/week until the HCT admission, with telematic weekly follow-ups. Its effectiveness is evaluated with the HCT Frailty Scale at admission

Ongoing results are evaluated prospectively, with all patients providing informed consent. The project that is part of a broader Frailty Program has been implemented using existing institutional resources. No external funding was obtained.

Results

From November 2023 to July 2024, 25 patients participated in the T-PreHab and were admitted for allo-HCT. The median age was 60 years. Acute myeloid leukemia (44%) was the most prevalent indications for allo-HCT. Seven patients (28%) had a KPS <90%, 6 (24%) had an HCT-CI >3, and 9 (36%) had a high/very high DRI. Most patients (n=18, 72%) received HLA-matched grafts, 14% (n=11) underwent MAC allo-HCT, and 96% (n=24) received PTCY. 24 (96%) patients were successfully discharged, though 2 (8%) died during follow-up, with one (4.0%) death due to NRM.

At first consultation, 9 patients (35.6%) were fit, 13 (52.0%) were pre-frail, and 3 (12.0%) were frail. After pre-hab and at HCT admission, 16 (64.0%) patients were fit, 8 (32.0%) were pre-frail, and 1 (4.0%) was frail. Specifically, all (100%) the fit patients remained fit, 6 (46.1%) of the 13 pre-frail patients became fit, 6 (46.1%) remained pre-frail, and 1 (7.6%) progressed to a frail state. All frail patients improved to better frailty states, with 1 (33.3%) patient progressing to a fit state and the other two (66.6%) to a pre-frail state. The median duration of the T-PreHab was 7 weeks, with no reported clinical complications. Patient program´s adherence was >80%.

The effectiveness of the T-PreHab was assessed comparing the evolution of frailty in patients participating in the program with that of patients who did not underwent pre-hab, and with patients that participated in the pilot PreHab (without telemedicine). The frailty status of the 59 non-prehabilitated patients evaluated for frailty between April 2021 and May 2022, remained largely unchanged: 35.6% / 35.6% fit, 54.2% / 52.5% pre frail, and 10.2% / 11.9% frail. In the 54 patients participating in the pilot PreHabP (June 2022 - October 2022), the proportion of fit patients increased from 24.1% to 46.3%, and pre-frail and frail proportions decreased from 64.8% to 50.0% and from 11.1% to 3.7%. With the T-PreHab, the fit proportion increased even more, from 37.0% to 64.0%, and pre-frail and frail proportions decreased from 52.0% to 32.0% and from 12.0% to 4.0%. Reductions on frailty trend to be statistically significant (p=0.064).

Conclusion

The frailty status of allo-HCT candidates is dynamic and can be positively treated through cost effective frailty evaluations and with tailored pre-hab programs implemented before allo-HCT. Telemedicine together with accessible and personalized care can enhance the cost-effectiveness of pre-hab programs.

Disclosures: Cid: Clínic Barcelona: Current Employment; Sanofi: Consultancy, Research Funding. Diaz-Ricart: Jazz Pharmaceuticals and Sanofi,: Speakers Bureau; Novartis Spain, CSL Behring, and Sysmex Europe GmbH.: Research Funding. Rosiñol Dachs: Amgen: Honoraria, Other: Educational lectures; Sanofi: Honoraria, Other: Honoraria for lectures; GSK: Honoraria, Other: Honoraria for lectures; BMS, Takeda, Pfizer, Menarini: Honoraria; Janssen Pharmaceutica: Honoraria, Other: Honoraria for lectures and meeting travel support. Martinez Munoz: Novartis: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees.

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