HCT Pre-App program: a telemedicine-based prehabilitation for allogeneic hematopoietic cell transplant candidates

Clinical Snapshot

Key Findings

• P Value: P = .001 for fitness improvement, P = .031 for frailty reduction

• Effect Size: Odds ratio 3.86 for being fit at admission with telemedicine prehabilitation

• Primary Outcome: Significant improvement in frailty status with telemedicine prehabilitation: fit patients increased from 34% to 56% (P = .001)

• Nnt Or Sensitivity: Number needed to treat approximately 5 patients to achieve one additional fit patient at transplant admission

• Confidence Interval: Not fully reported for primary outcome

Clinical Application

High feasibility demonstrated with 76-88% adherence rates and no adverse events reported Highly applicable to Australian practice given established telemedicine infrastructure and rehabilitation physician workforce. Could integrate with existing pre-transplant pathways and potentially qualify for Medicare telehealth rebates Allogeneic HCT candidates with measurable frailty, particularly those with 6+ weeks pre-transplant lead time

Abstract

Frailty has emerged as a key component of allo-HCT candidate assessment and is closely associated with transplant outcomes. Exercise-based prehabilitation may improve transplant candidacy, yet real-world implementation is limited. Our institution implemented a structured Frailty Program (FP) to assess frailty and introduce prehabilitation interventions. This study describes the program's evolution and evaluates the impact of prehabilitation. Between April 2021 and April 2025, 185 consecutive allo-HCT candidates were included in 3 sequential FP phases. In the first phase (No-Prehab, n = 76), patients underwent frailty assessment only. In the second phase (Pilot-Prehab, n = 59), patients received a home-based, nonsupervised prehabilitation program. In the third phase (Tele-Prehab, n = 50), patients participated in the HCT Pre-App Program, a structured digital telemedicine intervention supervised by rehabilitation physicians. Frailty was assessed at first consultation and HCT admission using the HCT Frailty Scale. Median prehabilitation duration was 6 weeks. Adherence was high across frailty groups (76%-88%), with no adverse events. Prehabilitation improved frailty status: fit patients increased from 22% to 42% in the Pilot-Prehab cohort (P = .009) and from 34% to 56% in the Tele-Prehab cohort (P = .001). Tele-Prehab independently increased the odds of being fit at admission (odds ratio [OR], 3.86; P = .001) and reduced frailty incidence (OR, 0.17; P = .031). One-year OS and NRM were comparable across cohorts (OS, 74.5%, 84.5%, and 78.1%; P = .367) with a trend toward lower NRM among prehabilitated patients (NRM, 14.6%, 5.1%, and 5.6%; P = .075). Frailty is dynamic in allo-HCT candidates, and results support how home-based digital prehabilitation improves fitness before transplantation.

References

1. 1.Salinas Gonzalez, R. S., Guardia, L., Solé, B., Moreno, C., de Llobet, N., Cascos, E., Martinez-Sanchez, J., Díaz-Ricart, M., Carreras, E., Antonio, M., Suárez-Lledó, M., Rosiñol, L., Closa, C., Sebio, R., Martínez, C., Fernández-Avilés, F., Rovira, M., & Salas, M. Q. (2026). HCT Pre-App program: a telemedicine-based prehabilitation for allogeneic hematopoietic cell transplant candidates. Blood Advances. https://doi.org/10.1182/bloodadvances.2025018378