Faculty Collaboration Database

CHARM is Prognostic of Geriatric Morbidity and Toxicity after Allogeneic Transplant for Older Adults: BMT CTN 1704 Study. Blood Adv 2025 Nov 21

Date

11/21/2025

Pubmed ID

41269781

DOI

10.1182/bloodadvances.2025018340

Abstract

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.

Author List

Artz AS, Logan BR, Saber W, Geller N, Bellach A, Kou J, Wood WA, McCarty J, Knight TG, Runaas L, Johnston L, Walston JD, Nakamura R, Mishra A, Uberti J, Dahi PB, Saultz JN, McCurdy SR, Morris LE Jr, Imus P, Hogan WJ, Nadiminti KV, Bhatt VR, Olin RL, Maakaron JE, Sobecks RM, Wall SA, Mattila D, Protz B, Devine SM, Horowitz MM, Sorror ML

Authors

Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Data Science Institute department at Medical College of Wisconsin