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Stem cell transplantation

The impact of individual comorbidities on non-relapse mortality following allogeneic hematopoietic stem cell transplantation

Leukemia volume 32, pages 1787–1794 (2018)Cite this article

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Abstract

Comorbidity burden is a well-established risk factor for non-relapse mortality (NRM) following allogeneic stem cell transplantation (allo-SCT). We evaluated whether individual comorbidities could better characterize NRM risk. Furthermore, given differing toxicity profiles of conditioning agents, we hypothesized that the hazard of comorbidities is exerted in a regimen-specific manner. This retrospective study included 875 adults treated with an allo-SCT. Six conditioning regimens were considered. Across the entire cohort and within each regimen, the hazard ratio (HR) for NRM associated with individual comorbidities was assessed using multivariable Cox regressions. In the overall population, renal dysfunction, hypoalbuminemia, and severe hepatic disease were associated with the highest risk of NRM (HR 2.1, HR 1.9, HR 1.7, respectively). The risk associated with specific comorbidities was modified by the conditioning regimen and was not correlated with intensity. In patients conditioned with fludarabine/busulfan (Flu/Bu4), NRM risk was increased with cardiac disease (HR 5.54). Severe pulmonary disease and a pre-existing infection were associated with increased NRM risk in patients receiving fludarabine/melphalan (HR 4.9) and fludarabine/treosulfan (HR 3.6), respectively. Comorbidities may exert effects unique to particular conditioning regimens, suggesting that regimen selection should be driven in part by specific comorbidities.

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Acknowledgements

This study was supported by The Varda and Boaz Dotan Research Center in Hemato-Oncology affiliated with the CBRC of Tel Aviv University and The Shalvi Foundation for the Support of Medical Research.

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Authors and Affiliations

  1. Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel

    Joshua A. Fein, Avichai Shimoni, Noga Shem-Tov, Ronit Yerushalmi, Hila Magen, Ivetta Danylesko, Arnon Nagler & Roni Shouval

  2. Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France

    Myriam Labopin

  3. Internal Medicine “F” Department, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel

    Nadav Furie

  4. The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel

    Eli Kopel

  5. Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel

    Roni Shouval

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  1. Joshua A. Fein
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Correspondence to Roni Shouval.

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Fein, J.A., Shimoni, A., Labopin, M. et al. The impact of individual comorbidities on non-relapse mortality following allogeneic hematopoietic stem cell transplantation. Leukemia 32, 1787–1794 (2018). https://doi.org/10.1038/s41375-018-0185-y

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