Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation.
Comorbidity measurements have recently been used to improve estimation of tolerance to allogeneic hematopoietic cell transplantation (HCT). We sought to determine the independent effect of comorbidity and performance status on HCT outcome and to devise a simple risk classification system for transplant-related mortality. We analyzed 105 consecutively enrolled patients who underwent HCT and received reduced intensity conditioning with fludarabine, melphalan, and alemtuzumab. Comorbid conditions were tabulated using 2 scales, the Charlson Comorbidity Index (CCI) and the Kaplan-Feinstein Scale (KFS). Comorbid conditions were found in 47% of patients by the KFS and in 27% by the CCI (P < .001). Using the Eastern Cooperative Oncology Group Performance Status (PS) scale, 34% had a PS score >0 (range, 0-2). A simple scale combining the KFS and PS enabled separation of high- from low-risk patients, with 6-month cumulative incidences 50% and 15%, respectively for transplant-related mortality (P = .001) and enhanced prognostic power over the CCI alone (P = .018). Prospective studies evaluating more comprehensive functional and comorbidity measurements are warranted.
Artz
Andrew S
AS
Section of Hematology/Oncology, University of Chicago, Chicago, Illinois 60637, USA. aartz@medicine.bsd.uchicago.edu <aartz@medicine.bsd.uchicago.edu>
Pollyea
Daniel A
DA
Kocherginsky
Masha
M
Stock
Wendy
W
Rich
Elizabeth
E
Odenike
Olatoyosi
O
Zimmerman
Todd
T
Smith
Sonali
S
Godley
Lucy
L
Thirman
Michael
M
Daugherty
Christopher
C
Extermann
Martine
M
Larson
Richard
R
van Besien
Koen
K
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000401:mortality*; D014184:Transplantation, Homologous; D016896:Treatment Outcome