Modified Frailty Index-11 (mFI-11) measured frailty as a predictor of post-transplant outcomes in non-Hodgkin's lymphoma patients undergoing hematopoietic stem cell transplantation: a retrospective analysis of National Inpatient Sample database
Clinical Snapshot
PICO Framework
| P — Population | Non-Hodgkin lymphoma patients aged 18-85 years undergoing hematopoietic stem cell transplantation (autologous or allogeneic) |
| I — Intervention | Modified Frailty Index-11 (mFI-11) assessment for frailty classification |
| C — Comparator | Non-frail patients (lower mFI-11 scores) |
| O — Outcomes | In-hospital mortality, unfavorable discharge, prolonged length of stay, complications, and healthcare costs |
Bottom Line
This large retrospective cohort study demonstrates that frailty, measured by the Modified Frailty Index-11, significantly predicts poor in-hospital outcomes following hematopoietic stem cell transplantation in non-Hodgkin lymphoma patients. Frail patients showed 7.5-fold higher mortality rates and increased rates of unfavorable discharge and prolonged hospital stays. While the study provides valuable evidence for pre-transplant risk stratification, it is limited by its focus on short-term hospital outcomes and lack of external validation. The mFI-11 appears to be a practical tool for identifying high-risk patients who may benefit from enhanced supportive care or alternative treatment approaches. However, clinicians should interpret these findings cautiously given the retrospective design and need for longer-term outcome data to fully inform transplant decision-making.
Key Findings
P Value: p < 0.001
Effect Size: 2.02% vs 0.27% mortality rate (frail vs non-frail)
Primary Outcome: In-hospital mortality in autologous HSCT patients
Nnt Or Sensitivity: 7.5-fold increased mortality risk in frail patients
Confidence Interval: Not provided in abstract
Clinical Application
mFI-11 is readily calculable from routine clinical data, making implementation straightforward Relevant to Australian haematology services; could inform PBS funding decisions and transplant centre protocols. Aligns with RACGP guidelines on comprehensive geriatric assessment NHL patients being considered for HSCT, particularly those with multiple comorbidities or advanced age
Abstract
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a critical treatment for non-Hodgkin lymphoma (NHL) but involves significant post-transplant risks. Frailty, measured by the Modified Frailty Index-11 (mFI-11), may influence outcomes. METHODS: We analyzed NHL patients undergoing autologous or allogeneic HSCT from the Nationwide Inpatient Sample (2016-2020). Frailty was defined by mFI-11, and outcomes included in-hospital mortality, unfavorable discharge, prolonged length of stay (LOS), complications, and costs. Multivariable regression models with stratification by age and Charlson Comorbidity Index were applied. RESULTS: Of 2807 patients (ages 18-85), frail patients were older and had more comorbidities. In autologous HSCT, frailty was linked to higher mortality (2.02% vs. 0.27%, p < 0.001), increased unfavorable discharges (19.75% vs. 10.80%, p < 0.0001), and prolonged LOS (15.92% vs. 7.75%, p < 0.0001). Similar trends were observed in the allogeneic cohort. CONCLUSIONS: Frailty predicts worse post-transplant outcomes in NHL patients undergoing HSCT, emphasizing the need for pre-transplant frailty screening.
References
- 1.Khan, A. H., Diaz-Riaño, J. N., Ijaz, E., Olatunji, A. O., Al Zoubi, M. A. M., Altamimi, A., Fidelugwuowo, K. D., & Akhtar, S. O. (2026). Modified Frailty Index-11 (mFI-11) measured frailty as a predictor of post-transplant outcomes in non-Hodgkin's lymphoma patients undergoing hematopoietic stem cell transplantation: A retrospective analysis of National Inpatient Sample database. Supportive Care in Cancer. https://doi.org/10.1016/j.bbmt.2012.11.006
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