title: Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma.
abstract: Autologous hematopoietic stem cell transplantation (AHCT) improves survival in patients with multiple myeloma (MM) but is associated with morbidity and nonrelapse mortality (NRM). Hematopoietic cell transplant comorbidity index (HCT-CI) was shown to predict risk of NRM and survival after allogeneic transplantation. We tested the utility of HCT-CI as a predictor of NRM and survival in patients with MM undergoing AHCT. We analyzed outcomes of 1156 patients of AHCT after high-dose melphalan reported to the Center for International Blood and Marrow Transplant Research. Individual comorbidities were prospectively collected at the time of AHCT. The impact of HCT-CI and other potential prognostic factors, including Karnofsky performance score (KPS), on NRM and survival were studied in multivariate Cox regression models. HCT-CI score was 0, 1, 2, 3, and >3 in 42%, 18%, 13%, 13%, and 14% of the study cohort, respectively. Subjects were stratified into 3 risk groups: HCT-CI score of 0 (42%) versus HCT-CI score of 1 to 2 (32%) versus HCT-CI score > 2 (26%). Higher HCT-CI was associated with lower KPS < 90 (33% of subjects score of 0 versus 50% in HCT-CI score > 2). HCT-CI score > 2 was associated with melphalan dose reduction (22% versus 10% in score 0 cohort). One-year NRM was low at 2% (95% confidence interval, 1% to 4%) and did not correlate with HCT-CI score (P = .9). On multivariate analysis, overall survival was inferior in groups with HCT-CI score of 1 to 2 (relative risk, 1.37, [95% confidence interval, 1.01 to 1.87], P = .04) and HCT-CI score > 2 (relative risk, 1.5 [95% confidence interval, 1.09 to 2.08], P = .01). Overall survival was also inferior with KPS < 90 (P < .001), IgA subtype (P ≤ .001), those receiving >1 pretransplant induction regimen (P = .007), and those with resistant disease at the time of AHCT (P < .001). AHCT for MM is associated with low NRM, and death is predominantly related to disease progression. Although a higher HCT-CI score did not predict NRM, it was associated with inferior survival.
authors.affiliation: Bone Marrow Transplantation Program, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Anuj
authors.initials: A
authors.lastname: Mahindra
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.affiliation: Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: William R
authors.initials: WR
authors.lastname: Drobyski
authors.affiliation: Department of Medicine, University of Texas Health Care System, San Antonio, Texas.
authors.forename: Cesar O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Visiting Professor of Hematology, Dept. of Medicine, Imperial College, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cristina J
authors.initials: CJ
authors.lastname: Gasparetto
authors.affiliation: Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.affiliation: Department of Medicine, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Division of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Amrita Y
authors.initials: AY
authors.lastname: Krishnan
authors.affiliation: Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.affiliation: Department of Molecular and Cellular Medicine, Bristol Children's Hospital, Bristol, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Marks
authors.affiliation: Department of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
authors.affiliation: Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Brentwood, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Manish
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mohamed L
authors.initials: ML
authors.lastname: Sorror
authors.affiliation: Department of Medicine, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Baldeep M
authors.initials: BM
authors.lastname: Wirk
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: phari@mcw.edu.
authors.forename: Parameswaran N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000276:immunology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan
keywords: Autologous hematopoietic cell transplantation; Comorbidity; Multiple myeloma; Transplant outcome