Blood Adv

Frailty has emerged as a key component of allo-HCT candidate assessment and is closely associated with transplant outcomes. Exercise-based prehabilitation may improve transplant candidacy, yet real-world implementation is limited. Our institution implemented a structured Frailty Program to assess frailty and introduce prehabilitation interventions. This study describes the program's sequential evolution and evaluates the feasibility and impact of prehabilitation. Between April 2021 and April 2025, 185 consecutive allo-HCT candidates were included in three sequential FP phases. In the first phase (No-Prehab, n=76), patients underwent frailty assessment only. In the second phase (Pilot-Prehab, n=59), patients received a home-based, non-supervised prehabilitation program. In the third phase (Tele-Prehab, n=50), patients participated in the HCT Pre-App Program, a structured digital telemedicine intervention supervised by rehabilitation physicians. Frailty was assessed at first consultation and HCT admission using the HCT Frailty Scale. Median prehabilitation duration was 6 weeks. Adherence was high across frailty groups (76-88%), with no exercise-related adverse events. Prehabilitation improved frailty status: fit patients increased from 22% to 42% in the Pilot-Prehab cohort (P=0.009) and from 34% to 56% in the Tele-Prehab cohort (P=0.001). Tele-Prehab independently increased the odds of being fit at admission (OR 3.86; P=0.001) and reduced frailty incidence (OR 0.17; P=0.031). One-year overall survival and non-relapse mortality were comparable across cohorts (OS: 74.5%, 84.5%, 78.1%, P=0.367) with a trend toward lower NRM among prehabilitated patients (NRM: 14.6%, 5.1%, 5.6%, P=0.075). Frailty is dynamic in allo-HCT candidates, and results support how home-based digital prehabilitation is feasible, safe, and improve fitness before transplantation.