Table 2.

Considerations to optimize vulnerable HCT patients

Domain impaired	Intervention
Significant comorbid conditions	Subspecialty consultation and management in context of transplant and disease
Impaired function	Structured prehabilitation, encourage and teach patient appropriate activity through transplant. Home assessment aligned with patient limitations
Limited social support	Pretransplant family meeting, assign “Team Captain,” and request secondary caregivers
Cognitive impairment	Delirium precautions, medication avoidance, and encourage greater presence of family support
Depression or anxiety	Recognize problem, cognitive ± medication management, and assess expected adherence post-HCT
Weight loss	Exclude concurrent medical problems, add supplements, and develop nutritional plan for transplant
Polypharmacy	Hold medications. Re-evaluate day 30 to 100 post-HCT
Any impairment	Adjust preparative regimen, donor source, and/or escalate posttransplant follow-up frequency. Assess posttransplant and modify intervention as needed. Enlist caregiver in optimization plan