Utility of comorbidity assessment in predicting transplantation-related toxicity following autologous hematopoietic stem cell transplantation for multiple myeloma.
Patients with coexisting medical problems may suffer increased toxicity and reduced quality of life after autologous hematopoietic stem cell transplantation (HSCT). The benefit of high-dose therapy for some patients with multiple myeloma (MM) is debatable. Decision tools that aid in identifying those patients with MM most suited for autologous HSCT may avoid the risk of excess toxicity. An objective assessment of comorbidities was performed in 126 patients with MM undergoing autologous HSCT using the Charlson comorbidity index (CCI), the hematopoietic cell transplantation comorbidity index (HCT-CI), and a modified pretransplantation assessment of mortality (mPAM) to determine the strength of association with increased transplantation-related toxicity and increased length of hospital stay (LOS). Any comorbidity scored using the CCI or HCT-CI (score > 0) was associated with an increased number of organ systems with serious toxicity (at least grade 2 toxicity using the Seattle criteria), an increased total sum of toxicity grades for all organs, and prolonged LOS. An mPAM score > or = 24 was associated with increased LOS. When considering autologous HSCT for a patient with MM, assessment of comorbidities using the CCI or HCT-CI may assist in predicting the risk of transplantation-related toxicity as an adjunct to physician judgment and patient preference.
Labonté
Laura
L
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada; Sprott Centre for Stem Cell Research, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Iqbal
Tariq
T
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Zaidi
Mukarram A
MA
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
McDiarmid
Sheryl A
SA
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada.
Huebsch
Lothar B
LB
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Tay
Jason
J
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Atkins
Harold
H
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Sprott Centre for Stem Cell Research, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Allan
David S
DS
The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Sprott Centre for Stem Cell Research, Ottawa Health Research Institute, Ottawa, Ontario, Canada. Electronic address: daallan@ohri.ca.
D000328:Adult; D000368:Aged; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous