Frailty among young survivors of bone marrow transplant has an incidence similar to that of the elderly population. That frailty increases the risk of death compared with nonfrail survivors.1

Frailty is characterized by exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss. It results in decreased physiologic reserve and less resistance to stressors. Among the general population 65 years and older, approximately 10% are frail.

Patients with blood cancers undergo hematopoietic cell transplantation (HCT) to cure or control their cancers. It exposes the patients to high-intensity chemotherapy, radiation, and immunosuppression, which can damage normal tissues. Unfortunately, the cure or control of the underlying disease is not accompanied by a full restoration of health because long-term HCT survivors are at increased risk for a host of chronic conditions.

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This study examined frailty in 998 HCT survivors and a group of 297 frequency-matched siblings. The HCT survivors had an average age of 42.5 years, had transplants between 1974 and 1998, and had survived at least 2 years after HCT. Frailty was defined as exhibiting 3 or more of the following characteristics: clinically underweight, exhaustion, low energy, slow walking speed, and muscle weakness.

The authors, led by Smita Bhatia, MD, MPH, of the University of Alabama at Birmingham, reported that the prevalence of frailty was 8.4% among HCT survivors, which approached the 10% prevalence found in elderly populations. Allogenic (donor) HCT recipients with chronic graft-vs-host disease were at increased risk of frailty.

Notably, the risk of subsequent death was increased more than 2-fold by frailty.

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The study was limited in that it included patients who had undergone transplantation between 1974 and 1998, and that there have been significant changes in transplant strategies in the past two decades.

“These data support the hypothesis that therapeutic exposures and the high risk of post-HCT complications constitute a substantial stressor, placing HCT survivors at risk for frailty, and provides potential evidence for premature aging in this population.… Finally, longitudinal surveillance of survivors is needed to identify those at highest risk and thus provide targeted interventions to prevent or improve adverse outcomes associated with frailty in this population,” the authors concluded.


1. Arora M, Sun CL, Ness KK, et al. Physiologic frailty in nonelderly hematopoietic cell transplantation patients: results from the bone marrow transplant survivor study [published online June 2, 2016]. JAMA Oncol. doi:10.1001/jamaoncol.2016.0855.