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Lymphoma

The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation

Leukemia volume 23, pages 1131–1138 (2009)Cite this article

Abstract

The hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been developed to identify patients at high risk of mortality after an allograft. Reduced-intensity/non-myeloablative regimens have decreased the non-relapse mortality (NRM) in elderly and/or heavily pretreated patients. We performed a retrospective study to assess whether HCT-CI may predict clinical outcomes in a cohort of 203 patients with non-Hodgkin's (NHL; n=108), Hodgkin's lymphomas (HL; n=26), and multiple myeloma (MM; n=69), who were transplanted from a human leucocyte antigen (HLA)-matched sibling (n=121) or an unrelated donor (n=82) after a reduced-intensity regimen (n=154) or a low-dose total body irradiation-based non-myeloblative regimen (n=49). Cumulative incidence of NRM was 5, 16 and 20% at 1 year and 6, 24 and 27% at 2 years, for patients with an HCT-CI of 0, 1–2 and ⩾3, respectively. By multivariate analysis, HCT-CI significantly predicted NRM (hazard ratio (HR)=1.6, P=0.03), overall survival (OS; HR=1.62, P<0.001) and progression-free survival (PFS; HR=1.43, P=0.002). Moreover, the Karnofsky performance status was also significantly associated with OS and NRM (HR=1.62, P<0.001 and HR=2.12, P=0.04, respectively). Conditioning type did not affect outcome after stratifying patients by HCT-CI. In the light of our study, all future prospective trials of the Gruppo Italiano Trapianti di Midollo (GITMO) will include the HCT-CI to stratify patients.

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Acknowledgements

This study was supported in part by Ricerca Finalizzata Regione Piemonte 2006 e 2007; Fondazione Cassa di Risparmio di Torino (CRT) (BM) and Comitato Regionale Piemontese Gigi Ghirotti (Progetto Vita Vitae) (BM); Fondazione Neoplasie Sangue Onlus (BM); Associazione Italiana Ricerca sul Cancro (AIRC) and Fondazione Michelangelo.

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Authors and Affiliations

  1. Hematology Department, IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy

    L Farina, F Spina, M Morelli & P Corradini

  2. Hematology Department, Ospedale San Giovanni Battista, University of Torino, Torino, Italy

    B Bruno, R Sorasio & M Boccadoro

  3. Hematology Department, Azienda Ospedaliera Santa Maria della Misericordia, University of Udine, Udine, Italy

    F Patriarca & R Fanin

  4. Chair of Hematology, University of Milano, Milano, Italy

    P Corradini

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  1. L Farina
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Correspondence to L Farina.

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Farina, L., Bruno, B., Patriarca, F. et al. The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation. Leukemia 23, 1131–1138 (2009). https://doi.org/10.1038/leu.2009.1

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