scholarly journals 81: Performance Status, but not the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Predicts Mortality at a Canadian Transplant Centre

2008 ◽  
Vol 14 (2) ◽  
pp. 32 ◽  
Author(s):  
R. Guilfoyle ◽  
A. Demers ◽  
E. Richardson ◽  
C. Bredeson ◽  
M. Seftel
Keyword(s):  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Performance Status ◽  
Hematopoietic Cell ◽  
Transplant Centre ◽  
Comorbidity Index

The Hematopoietic Cell Transplantation Comorbidity Index: No Effect on Outcome of Reduced-Intensity Allografts.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1119-1119
Author(s):  
O. Frankfurt ◽  
J. Altman ◽  
J. Krishnamurthy ◽  
Andrew M Evens ◽  
L. Gordon ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Performance Status ◽  
Univariate Analysis ◽  
Hematopoietic Cell ◽  
Refractory Disease ◽  
Score Distribution ◽  
Comorbidity Index ◽  
Reduced Intensity

Abstract The hematopoietic cell transplantation-comorbidity index (HCT-CI) has been proposed as a means to estimate the risk of transplant-related mortality (TRM) and the likelihood of overall survival (OS) after allogeneic HSCT. However, its value and applicability remain unclear; in a 2-center study, it was predictive of outcome at one but not at the other in multivariate analysis (Blood2007;110:4606). We investigated the effect of HCT-CI in 130 adult patients with hematologic malignancies undergoing reduced-intensity HSCT after 100 mg/m2 melphalan (+ 50 mg/kg cyclophosphamide if no prior autograft). GVHD prophylaxis comprised cyclosporine/tacrolimus and MMF. 18% of the donor-patient pairs were 1 antigen/allele-mismatched. 57% had refractory disease. 45% had failed an autograft. ECOG performance status (PS) was 0–34%, 1–48%, 2–14%, and 3–4%. The HCT-CI score distribution was 0–10%, 1–4%, 2–28%, 3–24%, 4–15%, 5–10%, 6–8%, and ≥7–2%. Overall, the patient population had higher HCT-CI scores than described in other studies (Cancer2008;112:1992). In multivariate analysis, TRM was higher with HLA mismatch and PS 2-3, and OS was lower with PS 2-3, HLA mismatch, refractory disease, donor age >45 y, elevated LDH, and platelets <100. HCT-CI 0 vs 1-2 vs ≥3 had no effect on TRM or OS. HCT-CI 0-2 vs ≥3 had a borderline effect on TRM (P=0.09) and OS (P=0.15) in univariate analysis, but no effect in multivariate analysis when forced into the model with factors known to be significant. No significant correlation was seen between HCT-CI and any of the factors found to be predictive of outcome. Figure Figure Because serum albumin is a powerful non-specific predictor of general health and outcome in all clinical situations, we hypothesized that it would correlate with the PS. As shown in the figure below, it did. We expected that it would correlate with HCT-CI because increasing comorbidity should theoretically be associated with declining albumin. However, it did not. Figure Figure In our experience, HCT-CI does not correlate with outcome – especially when other pertinent factors are taken into account. Since most data supporting HCT-CI have originated from a single center, it is possible that its applicability depends on individual centers and the treatment protocols employed. However, lack of correlation of HCT-CI with albumin does call its biological plausibility into some question. HCT-CI cannot be employed unless refined and validated prospectively in multi-center studies.

scholarly journals 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 ◽  
Vol 110 (13) ◽  
pp. 4606-4613 ◽  
Author(s):  
Mohamed L. Sorror ◽  
Sergio Giralt ◽  
Brenda M. Sandmaier ◽  
Marcos De Lima ◽  
Munir Shahjahan ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Hematopoietic Cell Transplantation ◽  
Survival Rates ◽  
Hematologic Malignancies ◽  
Hematopoietic Cell ◽  
Cancer Center ◽  
Comorbidity Index ◽  
Acute Myeloid

A new hematopoietic cell transplantation–specific comorbidity index (HCT-CI) was effective in predicting outcomes among patients with hematologic malignancies who underwent HCT at Fred Hutchinson Cancer Research Center (FHCRC). Here, we compared the performance of the HCT-CI to 2 other indices and then tested its capacity to predict outcomes among 2 cohorts of patients diagnosed with a single disease entity, acute myeloid leukemia in first complete remission, who underwent transplantation at either FHCRC or M. D. Anderson Cancer Center (MDACC). FHCRC patients less frequently had unfavorable cytogenetics (15% versus 36%) and HCT-CI scores of 3 or more (21% versus 58%) compared with MDACC patients. We found that the HCT-CI had higher sensitivity and outcome predictability compared with the other indices among both cohorts. HCT-CI scores of 0, 1 to 2, and 3 or more predicted comparable nonrelapse mortality (NRM) among FHCRC and MDACC patients. In multivariate models, HCT-CI scores were associated with the highest hazard ratios (HRS) for NRM and survival among each cohort. The 2-year survival rates among FHCRC and MDACC patients were 71% versus 56%, respectively. After adjustment for risk factors, including HCT-CI scores, no difference in survival was detected (HR: 0.98, P = .94). The HCT-CI is a sensitive and informative tool for comparing trial results at different institutions. Inclusion of comorbidity data in HCT trials provides valuable, independent information.

Hematopoietic cell transplantation comorbidity index predicts transplantation outcomes in pediatric patients

Blood ◽  
2011 ◽  
Vol 117 (9) ◽  
pp. 2728-2734 ◽  
Author(s):  
Angela R. Smith ◽  
Navneet S. Majhail ◽  
Margaret L. MacMillan ◽  
Todd E. DeFor ◽  
Sonata Jodele ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cell Transplantation ◽  
Pediatric Patients ◽  
Hematopoietic Cell Transplantation ◽  
Risk Groups ◽  
Hematopoietic Cell ◽  
Relative Risks ◽  
Innovative Therapies ◽  
Comorbidity Index

Abstract Quantifying the risk of hematopoietic cell transplantation (HCT)–related mortality for pediatric patients is challenging. The HCT-specific comorbidity index (HCT-CI) has been confirmed as a useful tool in adults, but has not yet been validated in children. We conducted a retrospective cohort study of 252 pediatric patients undergoing their first allogeneic HCT between January 2008 and May 2009. Pretransplantation comorbidities were scored prospectively using the HCT-CI. Median age at transplantation was 6 years (range, 0.1-20) and median follow-up was 343 days (range, 110-624). HCT-CI scores were distributed as follows: 0, n = 139; 1-2, n = 52; and 3+, n = 61. The 1-year cumulative incidence of nonrelapse mortality (NRM) increased (10%, 14%, and 28%, respectively; P < .01) and overall survival (OS) decreased (88%, 67%, and 62%, respectively; P < .01) with increasing HCT-CI score. Multivariate analysis showed that compared with score 0, those with scores of 1-2 and 3+ had relative risks of NRM of 1.5 (95% confidence interval, 0.5-4.3, P = .48) and 4.5 (95% confidence interval, 1.7-12.1, P < .01), respectively. These results indicate that the HCT-CI score predicts NRM and OS in pediatric patients undergoing HCT and is a useful tool to assess risk, guide counseling in the pretransplantation setting, and devise innovative therapies for the highest risk groups.

Refined Disease Risk Index (DRI) and Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) Predict Survival after Haploidentical Stem Cell Transplantation: A Comparative Study with EBMT Risk Score in 220 Consecutive Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4400-4400 ◽  
Author(s):  
Maria Teresa Lupo-Stanghellini ◽  
Elisa Sala ◽  
Simona Piemontese ◽  
Mara Morelli ◽  
Raffaella Greco ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Stem Cell ◽  
Cell Transplantation ◽  
Risk Score ◽  
Hematopoietic Cell Transplantation ◽  
Disease Risk ◽  
Risk Index ◽  
Hematopoietic Cell ◽  
Comorbidity Index ◽  
Very High

Abstract Background Optimization of pre-transplant risk assessment is a crucial issue to improve the allo-HSCT decision making process. Actually 3 major algorithms are in use in clinical practice: the EBMT risk score, the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score and - more recently introduced - the refined Disease Risk Index (DRI). DRI was defined to calibrate HSCT outcome across studies and centers. It was developed as a tool to assign patients into risk groups based on disease type and status at the time of transplantation. The aim of the DRI is to provide a robust tool that can be used for prognostication, for the analysis and interpretation of retrospective data, whether conducted in single-center, multicenter, or registry settings, or within the context of the federally mandated center outcome reporting. The DRI can also be used for the stratification of patients entering prospective HCT clinical trials. DRI is not a fixed tool but instead it was conceived to be refined by the transplant community as new information becomes available. Here we are presenting the results of a retrospective study designed to evaluate the 3 aforementioned score in stratification and prognostication of transplant outcome after a haploidentical HSCT (haplo-HSCT). Patients and Methods We included 220 adult patients (pts - 138 male, 82 female) who underwent a haplo-HSCT for hematologic malignancies, between 2006 and 2014 and were reported to our Institutional database. Risk assessment score and outcome analysis included all consecutive pts receiving an haplo-HSCT as 1st allogeneic transplantation. Pts receiving haplo-HSCT as 2nd or 3rd HSCT were excluded from the present analysis. Median age was 49 years (range, 15-77). The cohort included a broad representation of diseases (138/220 acute leukemia, 30 Hodgkin lymphoma); 62 pts were in complete remission at transplant, 158 were presenting active disease. Conditioning regimens mostly rely upon the combination of treosulfan plus fludarabine (201/220) and total body irradiation (range 200 - 400 cGy) was utilized in 52 patients. GVHD prophylaxis consisted mostly of an mTor inhibitor (rapamycin) combined with mycophenolate mofetil. The majority of patients received peripheral blood stem cells from a family haploidentical donor as stem cell source, while only 4 patients received bone marrow transplant. A written consent was given by pts allowing the use of medical records for research in accordance with the Declaration of Helsinki. Results The median follow-up for survivors was 37 months (r 6-107). The overall survival (OS) at 2-y was 35% and the transplant related mortality at 100-days 23%. The 2y OS according to EBMT / HCT-CI / DRI risk score are reported in table 1.a and figure 1. The evaluation of the HCT-CI impact after DRI stratification was able to show a significant difference in outcome showing better survival for pts with low DRI score and low HCT-CI score as expected (table 1.b). Discussion Refined DRI score and HCT-CI score predict survival after haplo-HSCT. The integrated application of refined DRI and HCT-CI may improve the definition of transplant eligibility for pts candidate to allogeneic HSCT form alternative donors including family haploidentical source. Table 1a. EBMT score 0-3 % pts 4-5 %pts > 5 %pts p 51% 17 34% 51 27% 32 0.07 HCT-CI score 0-2 3-4 >/= 5 48% 59 36% 31 0% 10 0.0001 DRI score Low-Intermediate High Very-High 61% 32 27% 51 5% 17 0.0001 Table 1b. HCT-CI 0-4 HCT-CI >/=5 p DRILow-Intermediate 64% 0% 0.0001 DRIHigh-Very High 29% 0% Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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