{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:54:29Z","timestamp":1782392069847,"version":"3.54.5"},"reference-count":41,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>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 developed and tested a new Simplified Geriatric Score-4 (SGS-4) on 135 consecutive patients aged \u226550 years who underwent allo-SCT between 2020 and 2023. Each CGA component was individually analyzed for its association with overall survival (OS), non-relapse mortality (NRM), and cumulative incidence of relapse (CIR). Then, we performed a two-factor analysis (FA) using oblimin rotation and Bartlett estimation on all CGA components and sex. Based on component weights, a simplified geriatric score-4 score (SGS-4) was created: [Gait Speed] + 2 \u00d7 [Hand Grip] + Geriatric 8 + 1.5 \u00d7 [Sex]. ROC analysis defined three fitness groups, frail (\u226413), prefrail (&gt;13\u201322.5), and fit (&gt;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\u2013Comorbidity 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 Simplified Geriatric Score-4 (SGS-4) based on three CGA domains (gait speed, hand grip, Geriatric 8) and sex effectively predicts OS and CIR risk in patients aged \u226550 years undergoing allo-SCT. The study\u2019s small sample size and disease heterogeneity warrant further validation in larger cohorts.<\/jats:p>","DOI":"10.3390\/cancers17203278","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T09:45:01Z","timestamp":1760089501000},"page":"3278","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development of a Simplified Geriatric Score-4 (SGS-4) to Predict Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation in Patients Aged over 50"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0911-404X","authenticated-orcid":false,"given":"Eugenia","family":"Accorsi Buttini","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Hematology Division, ASST Spedali Civili Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Zucchelli","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Tura","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8097-5988","authenticated-orcid":false,"given":"Gianluca","family":"Bianco","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-4170","authenticated-orcid":false,"given":"Daniele","family":"Avenoso","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Campisi","sequence":"additional","affiliation":[{"name":"Laboratorio Centrale di Analisi Chimico Cliniche, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2980-9028","authenticated-orcid":false,"given":"Mirko","family":"Farina","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Magliano","sequence":"additional","affiliation":[{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0406-6579","authenticated-orcid":false,"given":"Enrico","family":"Morello","sequence":"additional","affiliation":[{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6605-1255","authenticated-orcid":false,"given":"Vera","family":"Radici","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6297-9697","authenticated-orcid":false,"given":"Nicola","family":"Polverelli","sequence":"additional","affiliation":[{"name":"Unit of Bone Marrow Transplantation and Cellular Therapies, Division of Hematology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4851-1825","authenticated-orcid":false,"given":"Alessandra","family":"Marengoni","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0907-130X","authenticated-orcid":false,"given":"Michele","family":"Malagola","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"},{"name":"Adult Bone Marrow Transplant Unit, ASST Spedali Civili of Brescia, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1038\/s41409-025-02524-2","article-title":"The 2023 EBMT report on hematopoietic cell transplantation and cellular therapies. Increased use of allogeneic HCT for myeloid malignancies and of CAR-T at the expense of autologous HCT","volume":"60","author":"Passweg","year":"2025","journal-title":"Bone Marrow Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/bjh.16355","article-title":"The role of allogeneic stem cell transplantation in the management of acute myeloid leukaemia: A triumph of hope and experience","volume":"188","author":"Loke","year":"2019","journal-title":"Br. J. Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1182\/hematology.2021000257","article-title":"Allogeneic Hema to Poi Etic Cell Trans Plan Ta Tion for Older Patients","volume":"2021","author":"Lin","year":"2021","journal-title":"Hematology"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Loke, J., Vyas, H., and Craddock, C. (2021). Optimizing Transplant Approaches and Post-Transplant Strategies for Patients With Acute Myeloid Leukemia. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.666091"},{"key":"ref_5","first-page":"96.e1","article-title":"GITMO Registry Study on Allogeneic Transplantation in Patients Aged \u226560 Years from 2000 to 2017: Improvements and Criticisms","volume":"28","author":"Malagola","year":"2022","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2912","DOI":"10.1182\/blood-2005-05-2004","article-title":"Hematopoietic cell transplantation (HCT)-specific comorbidity index: A new tool for risk assessment before allogeneic HCT","volume":"106","author":"Sorror","year":"2005","journal-title":"Blood"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1016\/j.bbmt.2015.04.004","article-title":"Prospective Validation of the Predictive Power of the Hematopoietic Cell Transplantation Comorbidity Index: A Center for International Blood and Marrow Transplant Research Study","volume":"21","author":"Sorror","year":"2015","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1038\/bmt.2016.141","article-title":"Up-to-Date Tools for Risk Assessment before Allogeneic Hemato-poietic Cell Transplantation","volume":"51","author":"Elsawy","year":"2016","journal-title":"Bone Marrow Transpl."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4346","DOI":"10.1200\/JCO.2008.19.9463","article-title":"Distress in Older Patients With Cancer","volume":"27","author":"Hurria","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/jama.1963.03060120024016","article-title":"Studies of Illness in the Aged. The index of Adl: A standardized measure of biological and phychological funcation","volume":"185","author":"Katz","year":"1963","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/geront\/9.3_Part_1.179","article-title":"Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living","volume":"9","author":"Lawton","year":"1969","journal-title":"Gerontologist"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.1093\/annonc\/mdr587","article-title":"Screening older cancer patients: First evaluation of the G-8 geriatric screening tool","volume":"23","author":"Bellera","year":"2012","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.jgo.2018.03.001","article-title":"Geriatric oncology screening tools for CGA-based interventions: Results from a phase II study of geriatric assessment and management for older adults with cancer","volume":"9","author":"Yokom","year":"2018","journal-title":"J. Geriatr. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","year":"2005","journal-title":"CMAJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.2010.1923","article-title":"Gait Speed and Survival in Older Adults","volume":"305","author":"Studenski","year":"2011","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1002\/jbmr.2492","article-title":"Developing Consensus Criteria for Sarcopenia: An Update","volume":"30","author":"McLean","year":"2015","journal-title":"J. Bone Miner. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1002\/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6","article-title":"The Mini-Cog: A Cognitive \u201cvital Signs\u201d Measure for Dementia Screening in Multi-Lingual Elderly","volume":"15","author":"Borson","year":"2000","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_19","first-page":"61","article-title":"Cognitive dysfunction among newly diagnosed older patients with hematological malignancy: Frequency, clinical indicators and predictors","volume":"48","author":"Aiki","year":"2017","journal-title":"Ultrasound Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"921","DOI":"10.3109\/10428194.2014.953142","article-title":"Comprehensive geriatric assessment is an essential tool to support treatment decisions in elderly patients with diffuse large B-cell lymphoma: A prospective multicenter evaluation in 173 patients by the Lymphoma Italian Foundation (FIL)","volume":"56","author":"Tucci","year":"2014","journal-title":"Leuk. Lymphoma"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/s41409-020-0979-1","article-title":"Pilot prospective study of Frailty and Functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation","volume":"56","author":"Salas","year":"2020","journal-title":"Bone Marrow Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.bbmt.2012.11.006","article-title":"Pilot Study of Comprehensive Geriatric Assessment (CGA) in Allogeneic Transplant: CGA Captures a High Prevalence of Vulnerabilities in Older Transplant Recipients","volume":"19","author":"Muffly","year":"2013","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.3324\/haematol.2014.103655","article-title":"Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients","volume":"99","author":"Muffly","year":"2014","journal-title":"Haematologica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jgo.2019.05.022","article-title":"The use of comprehensive geriatric assessment in older patients before allologeneic hematopoietic stem cell transplantation: A cross-sectional study","volume":"11","author":"Rodrigues","year":"2020","journal-title":"J. Geriatr. Oncol."},{"key":"ref_25","first-page":"498.e1","article-title":"Geriatric Assessment Reveals Actionable Impairments in Hematopoietic Stem Cell Transplantation Candidates Age 18 to 80 Years","volume":"28","author":"Lew","year":"2022","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1038\/s41409-020-0934-1","article-title":"Multidimensional geriatric assessment for elderly hematological patients (\u226560 years) submitted to allogeneic stem cell transplantation. A French\u2013Italian 10-year experience on 228 patients","volume":"55","author":"Polverelli","year":"2020","journal-title":"Bone Marrow Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1038\/s41409-017-0021-4","article-title":"Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: A prospective risk factor and serial assessment analysis","volume":"53","author":"Deschler","year":"2018","journal-title":"Bone Marrow Transplant."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3488","DOI":"10.1182\/bloodadvances.2019000790","article-title":"Results from a multidisciplinary clinic guided by geriatric assessment before stem cell transplantation in older adults","volume":"3","author":"Derman","year":"2019","journal-title":"Blood Adv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1080\/10428194.2025.2451723","article-title":"Assessment of frailty and comorbidities in cellular therapies patients in Italy: Results of the GITMO Elderly-Survey (GITMO ELD-Survey)","volume":"66","author":"Malagola","year":"2025","journal-title":"Leuk. Lymphoma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1200\/JCO.21.00102","article-title":"Sarcopenia in the Older Adult With Cancer","volume":"39","author":"Williams","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.tipsro.2020.10.001","article-title":"Sarcopenia in cancer: Risking more than muscle loss","volume":"16","author":"Anjanappa","year":"2020","journal-title":"Tech. Innov. Patient Support Radiat. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100215","DOI":"10.1016\/j.jnha.2024.100215","article-title":"Prognostic impact of neurocognitive disorders in older patients with cancer: The ELCAPA prospective cohort study","volume":"28","author":"Conti","year":"2024","journal-title":"J. Nutr. Health Aging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jgo.2014.08.005","article-title":"PPT and VES-13 in elderly patients with cancer: Evaluation in multidimensional geriatric assessment and prediction of survival","volume":"5","author":"Augschoell","year":"2014","journal-title":"J. Geriatr. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1200\/JCO.20.02465","article-title":"Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi","volume":"39","author":"Merli","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_35","first-page":"415.e1","article-title":"Preconditioning Frailty Phenotype Influences Survival and Relapse for Older Allogeneic Transplantation Recipients","volume":"30","author":"Sung","year":"2024","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.breast.2021.08.005","article-title":"Population-based recurrence rates among older women with HR-positive, HER2-negative early breast cancer: Clinical risk factors, frailty status, and differences by race","volume":"59","author":"Zhou","year":"2021","journal-title":"Breast"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Morello, E., Guarinoni, M.G., Arena, F., Andreoli, M., Bernardi, S., Malagola, M., Turra, A., Polverelli, N., and Russo, D. (2021). A Systematic Review of the Literature and Perspectives on the Role of Biomarkers in the Management of Malnutrition After Allogeneic Hematopoietic Stem Cell Transplantation. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.535890"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/PPO.0000000000000645","article-title":"The Microbiome and Its Impact on Allogeneic Hematopoietic Cell Transplantation","volume":"29","author":"Malard","year":"2023","journal-title":"Cancer J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.3324\/haematol.2016.145847","article-title":"The prognostic value of serum C-reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes","volume":"101","author":"Artz","year":"2016","journal-title":"Haematologica"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1007\/s12185-016-1941-2","article-title":"Prognostic value of pretransplant serum C-reactive protein in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation","volume":"103","author":"Yamamoto","year":"2016","journal-title":"Int. J. Hematol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Salas, M.Q., Solano, M.T., Gonz\u00e1lez, M.B., G\u00f3mez, M.A., Fox, L., Artigas, M.d.M.P., Santamar\u00eda, A., Gonz\u00e1lez, M.d.C.Q., Salinas, A.S., and Camacho, J.M.S. (2025). Frailty assessment in adults undergoing allogeneic hematopoietic cell transplantation: Insights from a multicenter GETH-TC study to optimize outcomes and care. Front. Immunol., 15.","DOI":"10.3389\/fimmu.2024.1512154"}],"updated-by":[{"DOI":"10.3390\/cancers18121913","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000}}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/20\/3278\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T12:41:26Z","timestamp":1782391286000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/20\/3278"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":41,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17203278"],"URL":"https:\/\/doi.org\/10.3390\/cancers17203278","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]}}}