title: Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A prospective multicenter validation study of the Kanto Study Group for Cell Therapy.
abstract: Recent advances in allogeneic hematopoietic stem cell transplantation have led to increasing use of this modality in older patients who tend to have been more heavily pretreated and have more comorbidities. Thus, the evaluation of comorbidity is of increasing importance to more precisely assess the benefits and risks of the transplantation procedure. Researchers from Seattle developed the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), which was associated with the risk of mortality in several retrospective studies. However, its clinical utility has not been extensively documented in prospective studies. The aim of the present study was to evaluate the utility of the HCT-CI prospectively in a multicenter setting. Overall survival (OS) and nonrelapse mortality (NRM) at 2 years were 59% and 20%, respectively (n = 243). We found that the HCT-CI in its original scale failed to predict OS and NRM in this set of patients. Thus, we applied a flexible HCT-CI risk scoring system (restratifying scores from 0 to 3 to indicate low risk, and scores of 4 or higher as high-risk). The flexible HCT-CI was found to predict 2-year NRM and OS better than the original HCT-CI (NRM: P = .01, OS: P = .003). In subgroup analysis, we evaluated the usefulness of the original HCT-CI for patients excluding those who received cord blood transplantation (n = 186). Both 2-year OS and 2-year NRM were not significantly different according to the original HCT-CI (P = .304, P = .996), but with the flexible HCT-CI, there were significant differences in 2-year OS and 2-year NRM (P = .005 and P = .005, respectively). Multivariate analysis identified age >50, performance status (PS) <90, donor type (HLA-mismatched/unrelated donor), and the flexible HCT-CI ≥4 as significant predictors for worse OS at 2 years. However, the flexible HCT-CI did not remain a significant predictor for NRM at 2 years in multivariate analysis, whereas age, PS, and donor type did. The HCT-CI did not consistently predict both NRM and OS, but it still can be a useful tool in combination with other factors, such as PS and age. Furthermore, the HCT-CI, although potentially useful for capturing pretransplantation comorbidity and risk assessment, may need further validation before its adoption for routine clinical use.
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. Electronic address: nakaya1016@yahoo.co.jp.
authors.forename: Aya
authors.initials: A
authors.lastname: Nakaya
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Rheumatology/Hematology/Infection Disease, Yokohama City University Hospital, Kanagawa, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Hematology, Chiba University Hospital, Chiba, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Yano
authors.affiliation: Department of Hematology, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.affiliation: Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.affiliation: Department of Hematology, Narita Red Cross Hospital, Chiba, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Aotsuka
authors.affiliation: Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yokota
authors.affiliation: Department of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.affiliation: Department of Hematology, Saiseikai Maebashi Hospital, Gunma, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sakura
authors.affiliation: Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Nanya
authors.affiliation: Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Saitoh
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012107:Research Design; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D019653:Myeloablative Agonists
keywords: Allogeneic hematopoietic stem cell transplantation; Flexible hematopoietic cell transplantation–specific comorbidity index; Prospective study