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Does one model fit all? Predicting non-relapse mortality after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 56, pages 1720–1722 (2021)Cite this article

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Allogeneic hematopoietic cell transplantation (HCT) is an established treatment that enables long-term survival for patients with hematological diseases; however, the risk of non-relapse mortality (NRM) is substantial, which makes precise prediction of NRM a matter of clinical importance. Existing models for assessing the risk of NRM in allogeneic HCT include the European Society for Blood and Marrow Transplantation (EBMT) score [1] and the HCT-specific comorbidity index (HCT-CI) [2], but their predictive accuracy is suboptimal.

We recently developed a comprehensive system for predicting NRM after allogeneic HCT during first complete remission (CR1) of acute myeloid leukemia (AML) [3]. After dividing 2344 patients randomly into a training set or a validation set, we first identified and scored five parameters—age, sex, performance status (PS), HCT-CI, and donor type—on the basis of their impact on NRM in patients in the training set. The new scoring system which was named “NRM-J index”, used the sum of the assigned scores to stratify patients into four distinct risk groups. The application of the NRM-J index to patients in the validation set had better discriminative capacity than did those of the EBMT score and the HCT-CI [3]. Despite the fact that the NRM-J index has been developed exclusively for patients with AML in CR1, it is based solely on patient- and transplantation-related factors, and does not include disease-related factors. This situation prompted us to evaluate whether the NRM-J index is effectively applicable to other diseases, and here we present the analytic results.

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Fig. 1: Non-relapse mortality according to the NRM-J index.

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Acknowledgements

This work was supported in part by a grant from the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development (AMED), grant number: 18ek0510023h0002, and a grant from the Aichi Cancer Research Foundation, grant number: 2020-1-11.

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Authors and Affiliations

  1. Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

  2. Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  3. Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  4. National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  5. Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Junya Kanda

  6. Jichi Medical University, Shimotsuke, Japan

    Yoshinobu Kanda

  7. Jichi Medical University Saitama Medical Center, Saitama, Japan

    Yoshinobu Kanda & Hideki Nakasone

  8. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  9. Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

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  1. Masamitsu Yanada
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  2. Naoyuki Uchida
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Correspondence to Masamitsu Yanada.

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Yanada, M., Uchida, N., Ichinohe, T. et al. Does one model fit all? Predicting non-relapse mortality after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 56, 1720–1722 (2021). https://doi.org/10.1038/s41409-021-01236-7

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