title: A modified EBMT risk score and the hematopoietic cell transplantation-specific comorbidity index for pre-transplant risk assessment in adult acute lymphoblastic leukemia.
abstract: BACKGROUND
  Disease stage is the most important prognostic parameter in allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia, but other factors such as donor/host histocompatibility and gender combination, recipient age, performance status and comorbidities need to be considered. Several scoring systems are available to predict outcome in HCT recipients; however, their prognostic relevance in acute lymphoblastic leukemia is not well defined.
  
  
  METHODS
  In the present study we evaluated a modified EBMT risk score (mEBMT) and the HCT-specific comorbidity index (HCT-CI) in 151 adult acute lymphoblastic leukemia patients who received allogeneic HCT from 1995 until 2007 at our center.
  
  
  RESULTS
  Disease status was first complete remission (CR1) (47%), CR>1 (21%) or no CR (32%). Overall survival (OS) at one, two and five years was 62%, 51% and 40% and non-relapse mortality (NRM) was 21%, 24% and 32%. Median mEBMT was 3 (0-6). Higher mEBMT was associated with inferior OS (hazard ratio per score unit (HR): 1.50, P<0.001), higher NRM (HR: 1.36, P=0.042) and higher relapse mortality (HR: 1.68, P<0.001). Disease stage was the predominant prognostic factor in this score. Comorbidities were present in 71% of patients with mild hepatic disease (29%), moderate pulmonary disease (28%) and infections (23%) being the most common. Median HCT-CI was 1 (0-9). In univariate analysis a trend for inferior OS (HR: 1.08, P=0.20) and higher NRM (HR: 1.14, P=0.11) with increasing HCT-CI was observed but the level of significance was not reached. In additional analyses we found that reduced Karnofsky Performance Status (KPS) was associated with inferior OS (HR: 1.34, P=0.023) and higher relapse mortality (HR: 1.71, P=0.001) when analyzed univariately. However, KPS was associated with disease stage and significance was lost in multivariate analysis.
  
  
  CONCLUSIONS
  The mEBMT was prognostic in our patient cohort with predominant influence of disease stage, whereas a trend but no significant prognostic value was observed for the HCT-CI.
authors.affiliation: Department of Hematology and Oncology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. theis.terwey@charite.de
authors.forename: Theis H
authors.initials: TH
authors.lastname: Terwey
authors.forename: Philipp G
authors.initials: PG
authors.lastname: Hemmati
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Ekkehart
authors.initials: E
authors.lastname: Dietz
authors.forename: Lam G
authors.initials: LG
authors.lastname: Vuong
authors.forename: Gero
authors.initials: G
authors.lastname: Massenkeil
authors.forename: Bernd
authors.initials: B
authors.lastname: Dörken
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000592:standards*; D006801:Humans; D017567:Karnofsky Performance Status / Q000592:standards*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011300:Preoperative Care / Q000009:adverse effects / Q000592:standards*; D012107:Research Design / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000592:standards*; D055815:Young Adult