Does the hematopoietic cell transplantation specific comorbidity index predict transplant outcomes? A validation study in a large cohort of umbilical cord blood and matched related donor transplants.
The hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been recently proposed to predict the probability of nonrelapse mortality (NRM) and overall survival (OS) in allogeneic HCT recipients while taking into account any pretransplant comorbidity. We tested the validity of the HCT-CI in a cohort of 373 adult HCT recipients (184 matched-related donor and 189 unrelated umbilical cord blood) who received a myeloablative (N = 150) or nonmyeloablative (N = 223) conditioning regimen. HCT-CI scores of 0, 1, 2, and > or =3 were present in 58 (16%), 56 (15%), 64 (17%), and 195 (52%) patients, respectively. Pulmonary conditions were the most common comorbidity. Cumulative incidence of NRM at 2 years was 10%, 20%, 24%, and 28% for HCT-CI scores of 0, 1, 2, and > or =3, respectively (P = .01). The corresponding probability of OS at 2 years was 72%, 67%, 51%, and 48%, respectively (P < .01). On multivariate analyses adjusted for recipient age, disease risk, donor source, and conditioning regimen intensity, the relative risks for NRM for HCT-CI scores of 1, 2, and > or =3 (compared to a score of 0) were 2.0 (95% confidence intervals, 0.8-5.3), 2.6 (1.0-6.7), and 3.2 (1.4-7.4), respectively. The risks for overall mortality were 1.2 (0.6-2.1), 2.0 (1.1-3.4), and 2.1 (1.3-3.3), respectively. In subgroup analyses, the HCT-CI score did not consistently predict NRM and OS among different donor sources and conditioning regimens. The HCT-CI, although a useful tool for capturing pretransplant comorbidity and risk-assessment, needs to be further validated prior to adopting it for routine clinical use.
Majhail
Navneet S
NS
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota. Electronic address: majha001@umn.edu.
Brunstein
Claudio G
CG
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
McAvoy
Sarah
S
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
DeFor
Todd E
TE
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Al-Hazzouri
Ahmed
A
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Setubal
Daniela
D
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Arora
Mukta
M
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Le
Chap T
CT
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Wagner
John E
JE
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
Weisdorf
Daniel J
DJ
Blood and Marrow Transplant Program, University Of Minnesota, Minneapolis, Minnesota.
D000328:Adult; D000367:Age Factors; D000368:Aged; D000741:Anemia, Aplastic / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality*; D018572:Disease-Free Survival; D046148:Donor Selection / Q000379:methods; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000401:mortality; D014184:Transplantation, Homologous