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Post-Transplant Complications

A modified comorbidity index for hematopoietic cell transplantation

Bone Marrow Transplantation volume 45, pages 933–938 (2010)Cite this article

Abstract

A recent validation analysis at our center among allogeneic hematopoietic cell transplant (HCT) recipients did not find the HCT-specific comorbidity index (HCT-CI) to clearly segregate patient's transplant-related risk. We hypothesized that the discriminating and predictive power of the HCT-CI for mortality could be improved by eliminating the assignment of categorical weights to comorbidities and instead replacing them with hazard ratios (HR) from a Fine and Gray adjusted regression model. This approach allowed us to look carefully at each component of the comorbidity index. We developed the modified comorbidity index (MCI) using a cohort of 444 adult allogeneic HCT recipients using a pure multiplicative model. Compared with low-risk patients, the HR for non-relapse mortality (NRM) using the HCT-CI was 1.3 (95% confidence intervals, 0.7–2.4) for intermediate risk and 1.6 (0.9–2.8) for high-risk patients, and with the MCI was 1.6 (0.9–2.8) and 2.7 (1.5–5.0), respectively. In conclusion, we are introducing the MCI which may have higher discriminating and predictive power for overall survival and NRM. Validation of the HCT-CI and the MCI in larger and separate cohorts of HCT recipients is still needed.

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Authors and Affiliations

  1. Biostatistics and Informatics Core, Masonic Cancer Center,

    T E DeFor & C T Le

  2. University of Minnesota, Minneapolis, MN, USA

    T E DeFor & C T Le

  3. Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA

    N S Majhail, D J Weisdorf, C G Brunstein, S McAvoy & M Arora

  4. Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA

    C T Le

Authors
  1. T E DeFor
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  2. N S Majhail
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  4. C G Brunstein
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  5. S McAvoy
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  6. M Arora
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  7. C T Le
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Correspondence to T E DeFor.

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DeFor, T., Majhail, N., Weisdorf, D. et al. A modified comorbidity index for hematopoietic cell transplantation. Bone Marrow Transplant 45, 933–938 (2010). https://doi.org/10.1038/bmt.2009.275

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