Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis.
BACKGROUND
It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general.


METHODS
Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5-77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005.


RESULTS
Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%-73%) for risk score 0 for the whole cohort (75%, 95% CI, 72%-78% for the most recent time cohort) to 24% (95% CI, 21%-27% for risk score 6 and 7; 25%, 95% CI, 22%-29% most recent cohort). Transplant-related mortality increased from 15% (95% CI, 14%-17%) for risk score 0 (11%, 95% CI, 9%-13%, most recent cohort) to 47% with risk score 6 and 7 (95% CI, 44%-50%) for the whole cohort (45%, 95% CI, 42%-48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques.


CONCLUSIONS
Five well-defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies.
Gratwohl
Alois
A
Department of Hematology, University Hospital, University of Basel, Basel, Switzerland. hematology@uhbs.ch
Stern
Martin
M
Brand
Ronald
R
Apperley
Jane
J
Baldomero
Helen
H
de Witte
Theo
T
Dini
Giorgio
G
Rocha
Vanderson
V
Passweg
Jakob
J
Sureda
Anna
A
Tichelli
André
A
Niederwieser
Dietger
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014184:Transplantation, Homologous