title: Hematopoietic cell transplantation comorbidity index (HCT-CI) is predictive of adverse events and overall survival in older allogeneic transplant recipients.
abstract: OBJECTIVE
  Our goal was to evaluate the ability of the hematopoietic cell transplantation comorbidity index (HCT-CI) to predict outcomes after allogeneic stem cell transplant (SCT) within the context of an older patient population, where multiple comorbidities are common.
  
  
  METHODS
  We performed a retrospective cohort study of SCT patients ≥50years of age at our institution, identifying 59 patients with complete HCT-CI data collected prospectively.
  
  
  RESULTS
  HCT-CI category distribution in our sample was disproportionate, with almost half of patients having scores ≥3. High HCT-CI score (≥3 vs <3) was associated with significantly inferior OS (median OS not reached for HCT-CI <3 vs 14months for HCT-CI ≥3; hazard ratio (HR) 2.2, p=0.02). HCT-CI score was a better predictor of OS than age, performance status or conditioning intensity. When adjusted for disease relapse risk, HCT-CI score conferred a worse prognosis in the low risk group (HR 1.43, p=0.03) but not in the intermediate/high risk group (HR 1.08, p=0.65). NRM was low in the total sample (6% at one year) and was not associated with HCT-CI score. Grade 3-4 non-hematologic adverse events within the first 100days after SCT were significantly more common in the higher HCT-CI groups (p=0.02).
  
  
  CONCLUSIONS
  In our older patient cohort with a high incidence of multiple comorbidities, HCT-CI score ≥3 was significantly associated with OS, particularly in the subset of patients with a low disease relapse risk.
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: Jkeller@DOM.wustl.edu.
authors.forename: Jesse W
authors.initials: JW
authors.lastname: Keller
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Andreadis
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Damon
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Lawrence D
authors.initials: LD
authors.lastname: Kaplan
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Martin
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Wolf
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Weiyun Z
authors.initials: WZ
authors.lastname: Ai
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Venstrom
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Smith
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Karin M L
authors.initials: KM
authors.lastname: Gaensler
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Hwang
authors.affiliation: Adult Blood and Marrow Transplant Program, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: rolin@medicine.ucsf.edu.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Olin
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006402:Hematologic Diseases / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D066027:Transplant Recipients / Q000706:statistics & numerical data; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D019653:Myeloablative Agonists
keywords: Allogeneic; Comorbidity; Elderly; Hematopoietic stem cell transplantation