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Impact of a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), on allogeneic transplant outcomes in patients with acute myeloid leukemia and myelodysplastic syndrome

Bone Marrow Transplantation volume 54, pages 839–848 (2019)Cite this article

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Abstract

Outcomes after allogeneic stem-cell transplantation (AHSCT) are influenced by both disease- and patient-related factors. Here, we developed a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), by combining the refined disease risk index (DRI-R) and hematopoietic stem-cell transplant comorbidity/age index (HCT-CI/Age) to predict post-transplant survival for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). The analysis included 942 AML/MDS patients treated with AHSCT. Patients were stratified into 4 HCT-CR risk groups: Low-risk—patients with low/intermediate DRI-R and HCT-CI/Age ≤3 (N = 272); Intermediate-risk—patients with low/intermediate DRI-R and HCT-CI/Age >3 (N = 168); High-risk—patients with high/very high DRI-R and HCT-CI/Age ≤3 (N = 284); and Very high-risk—patients with high/very high DRI-R and HCT-CI/Age >3 (N = 184). Compared with the low-risk group, intermediate, high, and very high-risk groups had a significantly increased risk of death [adjusted HR of 1.37 (P < 0.04), 2.08 (P < 0.001), and 2.92 (P < 0.001), respectively]. The concordance test showed that the HCT-CR model provided better discriminative capacity for OS prediction compared with all prior models independently, including cytogenetic risk group, DRI-R, and HCT-CI/Age model (C-indices: 0.62, 0.55, 0.60, and 0.54, respectively) (P < 0.001). In conclusion, combining disease- and patient-related factors provides better survival stratification for patients with AML/MDS receiving AHSCT.

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Author contributions

PK contributed with study design, data analysis, interpretation, and wrote the manuscript; SP contributed with interpretation of the study results, reviewed and approved the manuscript; DRM contributed with data analysis, interpretation of the results, wrote, reviewed and approved the manuscript; JMRP contributed with manuscript writing, reviewed and approved the manuscript; GR, JC, and AC contributed with data collection, reviewed and approved the manuscript; GA, AA, BSA, JSI, CMH, QB, IK, PK, BO, UP, and RC contributed with treatment of patients, reviewed and approved the manuscript; SOC contributed with study design, data collection and interpretation of results, and manuscript writing.

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Authors and Affiliations

  1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Piyanuch Kongtim, Simrit Parmar, Jorge Miguel Ramos Perez, Gabriela Rondon, Julianne Chen, Abhishek R. Chilkulwar, Gheath Al-Atrash, Amin Alousi, Borje S. Andersson, Jin S. Im, Chitra M. Hosing, Qaiser Bashir, Issa Khouri, Partow Kebriaei, Betul Oran, Uday Popat, Richard Champlin & Stefan O. Ciurea

  2. Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand

    Piyanuch Kongtim

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Denái R. Milton

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  1. Piyanuch Kongtim
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  2. Simrit Parmar
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Correspondence to Stefan O. Ciurea.

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Kongtim, P., Parmar, S., Milton, D.R. et al. Impact of a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), on allogeneic transplant outcomes in patients with acute myeloid leukemia and myelodysplastic syndrome. Bone Marrow Transplant 54, 839–848 (2019). https://doi.org/10.1038/s41409-018-0344-9

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