title: The hematopoietic cell transplantation-specific comorbidity index fails to predict outcomes in high-risk AML patients undergoing allogeneic transplantation--investigation of potential limitations of the index.
abstract: In the context of allogeneic hematopoietic cell transplantation (allo-HSCT), comorbidities are an important risk factor. Use of the hematopoietic cell transplantation-specific comorbidity index (HSCT-CI), which was developed and validated in Seattle, Washington, has been proposed to predict the probability of nonrelapse mortality (NRM) and overall survival (OS) following allo-HSCT. We performed a single-center retrospective study to validate the prognostic impact of HSCT-CI on transplant outcomes in a cohort of high-risk acute myeloid leukemia patients undergoing allo-HSCT between January 2000 and December 2008. The median patient age at the time of transplantation was 53 years (range: 11-76 years). The median pretransplantation HSCT-CI score was 4 (range: 0-10). Among 340 patients, OS at 3 years was 29% (95% confidence interval [CI]: 17%-41%), 40% (33%-47%), and 44% (41%-47%) in the low-, intermediate-, and high-risk HSCT-CI groups (P = .7), respectively. The corresponding NRM at 3 years was 34% (10%-58%), 32% (20%-44%), and 26% (20%-32%; P = .6). In multivariate analysis, we found no predictive value of HSCT-CI for either OS or NRM. The use of HSCT-CI as a decision-making tool for transplantation eligibility should not be considered until its validity has been unequivocally shown in crossvalidation studies.
authors.affiliation: Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany. nicole.birninger@uniklinikum-dresden.de
authors.forename: Nicole
authors.initials: N
authors.lastname: Birninger
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.forename: Markus
authors.initials: M
authors.lastname: Schaich
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.forename: Johannes
authors.initials: J
authors.lastname: Schetelig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult