# Development of a Simplified Geriatric Score-4 (SGS-4) to Predict Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation in Patients Aged over 50

## TL;DR

Researchers developed a simplified geriatric score (SGS-4) to predict outcomes for older patients undergoing stem cell transplants, using just four factors.

## Contribution

The SGS-4 is a new, simplified tool for geriatric assessment in transplant patients, combining gait speed, hand grip, Geriatric 8, and sex.

## Key findings

- SGS-4 stratified patients into fit, pre-frail, and frail categories with distinct survival and relapse outcomes.
- Reduced hand grip strength and impaired MMSE were linked to worse survival and higher non-relapse mortality.
- The SGS-4 showed better prognostic value than other CGA domains and the HCT-CI.

## Abstract

Allogeneic stem cell transplantation represents a potentially curative option for several hematologic malignancies; however, assessing patient fitness, particularly in older adults, remains a clinical challenge. The Comprehensive Geriatric Assessment (CGA) is the gold standard for evaluating functional, cognitive, and physical domains, but its complexity limits routine application. In this prospective study, we developed and validated a Simplified Geriatric Score-4 (SGS-4) that includes only gait speed, hand grip strength, the Geriatric 8 questionnaire, and sex. Among patients aged 50 years or older undergoing transplantation, SGS-4 effectively stratified individuals into three fitness categories—fit, pre-frail, and frail—each associated with distinct survival and relapse outcomes. This simplified tool may facilitate the integration of geriatric assessment into everyday transplant practice, enabling more accurate risk stratification and personalized treatment planning for older patients.

Background: The Comprehensive Geriatric Assessment (CGA) has proven to be a valuable tool for providing a more comprehensive health evaluation of allogeneic stem cell transplantation (allo-SCT) recipients. Methods: We prospectively conducted a CGA in 135 consecutive patients aged ≥50 years who underwent allo-SCT between 2020 and 2023. Each CGA domain was individually analyzed for its association with overall survival (OS), non-relapse mortality (NRM), and cumulative incidence of relapse (CIR). Subsequently, a Simplified Geriatric Score-4 (SGS-4) was developed in a subset of 99 patients using two-factor analysis (FA) with oblimin rotation and Bartlett’s method applied to all CGA domains and sex. Based on the derived component weights, the SGS-4 formula was established as follows [Gait Speed] + 2 × [Hand Grip] + Geriatric 8 + 1.5 × [Sex]. ROC analysis defined three fitness groups, frail (≤13), prefrail (>13–22.5), and fit (>22.5). Results: Reduced hand grip strength and impaired mini mental state examination (MMSE) were associated with worse OS and higher NRM. Vulnerable Elders Survey (VES-13) and Fondazione Italiana Linfomi (FIL) scores also indicated poorer OS, though with uneven group sizes. Other CGA domains and the Hematopoietic Cell Transplantation–Comorbidity Index (HCT-CI) showed no significant prognostic value. The SGS-4 effectively stratified patients into three fitness groups, with those in the frail category experiencing lower OS and an increased risk of relapse. Conclusions: The new SGS-4 based on three CGA domains (gait speed, hand grip, Geriatric 8) and sex effectively predicts OS and CIR risk in patients aged ≥50 years undergoing allo-SCT. The study’s small sample size and disease heterogeneity warrant further validation in larger cohorts.