title: Hematopoietic cell transplantation comorbidity index predicts transplantation outcomes in pediatric patients.
abstract: Quantifying the risk of hematopoietic cell transplantation (HCT)-related mortality for pediatric patients is challenging. The HCT-specific comorbidity index (HCT-CI) has been confirmed as a useful tool in adults, but has not yet been validated in children. We conducted a retrospective cohort study of 252 pediatric patients undergoing their first allogeneic HCT between January 2008 and May 2009. Pretransplantation comorbidities were scored prospectively using the HCT-CI. Median age at transplantation was 6 years (range, 0.1-20) and median follow-up was 343 days (range, 110-624). HCT-CI scores were distributed as follows: 0, n=139; 1-2, n=52; and 3+, n=61. The 1-year cumulative incidence of nonrelapse mortality (NRM) increased (10%, 14%, and 28%, respectively; P<.01) and overall survival (OS) decreased (88%, 67%, and 62%, respectively; P<.01) with increasing HCT-CI score. Multivariate analysis showed that compared with score 0, those with scores of 1-2 and 3+ had relative risks of NRM of 1.5 (95% confidence interval, 0.5-4.3, P=.48) and 4.5 (95% confidence interval, 1.7-12.1, P<.01), respectively. These results indicate that the HCT-CI score predicts NRM and OS in pediatric patients undergoing HCT and is a useful tool to assess risk, guide counseling in the pretransplantation setting, and devise innovative therapies for the highest risk groups.
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN 55455, USA. smith719@umn.edu
authors.forename: Angela R
authors.initials: AR
authors.lastname: Smith
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Todd E
authors.initials: TE
authors.lastname: DeFor
authors.forename: Sonata
authors.initials: S
authors.lastname: Jodele
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Lehmann
authors.forename: Robert
authors.initials: R
authors.lastname: Krance
authors.forename: Stella M
authors.initials: SM
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D007231:Infant, Newborn; D015999:Multivariate Analysis; D012008:Recurrence; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult