title: Combination of the Hematopoietic Cell Transplantation Comorbidity Index and the European Group for Blood and Marrow Transplantation score allows a better stratification of high-risk patients undergoing reduced-toxicity allogeneic hematopoietic cell transplantation.
abstract: This study was conducted to determine whether the integration of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score would improve individual capacity for stratification of high-risk HCT candidates. A total of 442 consecutive patients receiving an allogeneic HCT after reduced-toxicity conditioning was included. Final HCT-CI and EBMT scores were calculated and validated. Then, patients were grouped into a 6-category new combination model according to the HCT-CI (0, 1 to 2, ≥ 3) and EBMT scores (0 to 3, 4 to 7), and the model's predictive capacity was also evaluated. Median HCT-CI and EBMT scores were 3 and 4, respectively. Increased HCT-CI was associated with higher 4-year nonrelapse mortality (NRM) and lower 4-year overall survival (OS), whereas a high EBMT score was associated with higher 4-year NRM. The HCT-CI showed a trend for a better predictive capacity than the EBMT score (c-statistic .6 versus .54, P = .1). According to the new model, patients within HCT-CI of 0 and HCT-CI of 1 to 2 groups had similar risk of NRM independently of their EBMT score. Within the HCT-CI ≥ 3 group, patients with low EBMT score showed lower NRM (25% versus 40%, P = .04) and a trend to higher OS (52% versus 36%, P = .06) than patients with a high EBMT score. Moreover, patients with HCT-CI ≥ 3 and EBMT score 0 to 3 had similar outcomes than those with HCT-CI of 1 to 2. In conclusion, the combination of HCT-CI and the EBMT score is feasible and might contribute to a better identification of high-risk patients, improving selection of best allogeneic HCT candidates.
authors.affiliation: Hematology Department, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: pebarba@vhebron.net.
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.affiliation: Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.affiliation: Hematology Department, Hospital Universitario, Salamanca, Salamanca, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Pérez-Simón
authors.affiliation: Hematology Department, Hospital Clínic, Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Hematology Department, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Castillo
authors.affiliation: Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.affiliation: Hematology Department, Hospital Universitario, Salamanca, Salamanca, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: López-Anglada
authors.affiliation: Hematology Department, Hospital Clínic, Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.affiliation: Hematology Department, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Bosch
authors.affiliation: Hematology Department, Hospital Clínic, Barcelona, Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.affiliation: Hematology Department, Hospital Universitario, Salamanca, Salamanca, Spain.
authors.forename: Lucía López
authors.initials: LL
authors.lastname: Corral
authors.affiliation: Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Blood and Tissue Bank of Catalonia, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.affiliation: Hematology Department, Hospital Universitari Vall d'Hebron-Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012008:Recurrence; D012107:Research Design / Q000706:statistics & numerical data*; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists
keywords: Allo-reduced-intensity conditioning; Comorbidity; EBMT score; HCT-CI; Reduced-intensity conditioning stem cell transplantation