A modified comorbidity index for hematopoietic cell transplantation.
A recent validation analysis at our center among allogeneic hematopoietic cell transplant (HCT) recipients did not find the HCT-specific comorbidity index (HCT-CI) to clearly segregate patient's transplant-related risk. We hypothesized that the discriminating and predictive power of the HCT-CI for mortality could be improved by eliminating the assignment of categorical weights to comorbidities and instead replacing them with hazard ratios (HR) from a Fine and Gray adjusted regression model. This approach allowed us to look carefully at each component of the comorbidity index. We developed the modified comorbidity index (MCI) using a cohort of 444 adult allogeneic HCT recipients using a pure multiplicative model. Compared with low-risk patients, the HR for non-relapse mortality (NRM) using the HCT-CI was 1.3 (95% confidence intervals, 0.7-2.4) for intermediate risk and 1.6 (0.9-2.8) for high-risk patients, and with the MCI was 1.6 (0.9-2.8) and 2.7 (1.5-5.0), respectively. In conclusion, we are introducing the MCI which may have higher discriminating and predictive power for overall survival and NRM. Validation of the HCT-CI and the MCI in larger and separate cohorts of HCT recipients is still needed.
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Biostatistics and Informatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA. defor001@umn.edu
Majhail
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Weisdorf
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Brunstein
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McAvoy
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Arora
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D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016019:Survival Analysis; D055815:Young Adult