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Stem Cells

Impact of comorbidity indexes on non-relapse mortality

Abstract

Comorbidity indexes (CI) have been reported to predict non-relapse mortality (NRM) and overall survival after allogeneic hematopoietic stem cell transplantation (HSCT) (Charlson's comorbidity index (CCI), hematopoietic cell transplantation CI (HCT-CI) and the pre-transplantation assessment of mortality (PAM) score). Which of these indexes best predict survival is unknown yet. We retrospectively studied 286 patients who underwent allogeneic HSCT. HCT-CI and PAM scores required grading according to pre-transplant pulmonary function tests (PFTs), which were lacking for some patients. We thus designed a reduced HCT-CI and an adjusted PAM, without results of PFTs. Using CCI, 25% of patients had indexes of 1 or more; median reduced HCT-CI score was 1; median adjusted PAM score was 24. The discriminative properties of the three CIs were rather low in our population. Comparison of patients and transplant characteristics between our and Seattle group's cohorts, however, revealed significant differences in more children, in more cord blood HSCT and in HSCT for Fanconi anemia in St Louis. Finally, multivariate analysis of scoring items revealed that age, matched unrelated or mismatched donor and hepatic disease were associated with NRM in our cohort. Translating use for patient's counseling or decision to proceed to transplant of these CIs will need prospective studies in a large independent cohort.

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References

  1. Bacigalupo A, Sormani MP, Lamparelli T, Gualandi F, Occhini D, Bregante S et al. Reducing transplant-related mortality after allogeneic hematopoietic stem cell transplantation. Haematologica 2004; 89: 1238–1247.

    PubMed  Google Scholar 

  2. Artz AS, Pollyea DA, Kocherginsky M, Stock W, Rich E, Odenike O et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12: 954–964.

    Article  PubMed  Google Scholar 

  3. Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    CAS  Article  Google Scholar 

  4. Extermann M . Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hemato 2000; 35: 181–200.

    CAS  Article  Google Scholar 

  5. Bolwell BJ . Are predictive factors clinically useful in bone marrow transplantation? Bone Marrow Transplant 2003; 32: 853–861.

    CAS  Article  PubMed  Google Scholar 

  6. Alamo J, Shahjahan M, Lazarus HM, de Lima M, Giralt SA . Comorbidity indices in hematopoietic stem cell transplantation: a new report card. Bone Marrow Transplant 2005; 36: 475–479.

    CAS  Article  PubMed  Google Scholar 

  7. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM . How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 2003; 56: 221–229.

    Article  PubMed  Google Scholar 

  8. Charlson M, Szatrowski TP, Peterson J, Gold J . Validation of a combined comorbidity index. J Clin Epidemiol 1994; 47: 1245–1251.

    CAS  Article  PubMed  Google Scholar 

  9. Diaconescu R, Flowers CR, Storer B, Sorror ML, Maris MB, Maloney DG et al. Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donors. Blood 2004; 104: 1550–1558.

    CAS  Article  PubMed  Google Scholar 

  10. Sorror ML, Maris MB, Storer B, Sandmaier BM, Diaconescu R, Flowers C et al. Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplantation comorbidities. Blood 2004; 104: 961–968.

    CAS  Article  PubMed  Google Scholar 

  11. Shahjahan M, Alamo J, de Lima M, Khouri I, Gajewski J, Andersson B et al. Effect of comorbidities on allogeneic hematopoietic stem cell transplant outcomes in AML/MDS patients in first complete remission. Biol Blood Marrow Transplant 2004; 10 (Suppl 1): S12–S13.

    Article  Google Scholar 

  12. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Parimon T, Au DH, Martin PJ, Chien JW . A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med 2006; 144: 407–414.

    Article  PubMed  Google Scholar 

  14. Kalbfleisch JD, Prentice RL . The Statistical Analysis of Failure Time Data. John Wiley & Sons: New York (NY), 1980, pp 163–178.

    Google Scholar 

  15. Harrell Jr FE, Lee KL, Califf RM, Pryor DB, Rosati RA . Regression modelling strategies for improved prognostic prediction. Stat Med 1984; 3: 143–152.

    Article  PubMed  Google Scholar 

  16. Harrell Jr FE . Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression and Survival Analysis. Springer-Verlag: New York (NY), 2001, pp 249–253.

    Book  Google Scholar 

  17. Sorror ML, Giralt S, Sandmaier BM, De Lima M, Shahjahan M, Maloney DG et al. Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 2007; 10: 4606–4613.

    Article  Google Scholar 

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Correspondence to G Socié.

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Xhaard, A., Porcher, R., Chien, J. et al. Impact of comorbidity indexes on non-relapse mortality. Leukemia 22, 2062–2069 (2008). https://doi.org/10.1038/leu.2008.197

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  • DOI: https://doi.org/10.1038/leu.2008.197

Keywords

  • comorbidities
  • allogeneic hematopoietic stem cell transplantation
  • non-relapse mortality
  • overall survival

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