title: Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation.
abstract: 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.
authors.affiliation: Section of Hematology/Oncology, University of Chicago, Chicago, Illinois 60637, USA. aartz@medicine.bsd.uchicago.edu <aartz@medicine.bsd.uchicago.edu>
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Pollyea
authors.forename: Masha
authors.initials: M
authors.lastname: Kocherginsky
authors.forename: Wendy
authors.initials: W
authors.lastname: Stock
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rich
authors.forename: Olatoyosi
authors.initials: O
authors.lastname: Odenike
authors.forename: Todd
authors.initials: T
authors.lastname: Zimmerman
authors.forename: Sonali
authors.initials: S
authors.lastname: Smith
authors.forename: Lucy
authors.initials: L
authors.lastname: Godley
authors.forename: Michael
authors.initials: M
authors.lastname: Thirman
authors.forename: Christopher
authors.initials: C
authors.lastname: Daugherty
authors.forename: Martine
authors.initials: M
authors.lastname: Extermann
authors.forename: Richard
authors.initials: R
authors.lastname: Larson
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
mesh_terms: 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