title: Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation.
abstract: OBJECTIVE
  Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cell transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown.
  
  
  METHODS
  Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age intervals and a validation set to assess the performance of prognostic models.
  
  
  RESULTS
  In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P = .29), 1.48 (P = .04), 1.75 (P = .004), and 1.84 (P = .005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P < .001) and survival (0.682 v 0.560; P < .001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens.
  
  
  CONCLUSIONS
  Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO. msorror@fhcrc.org.
authors.forename: Mohamed L
authors.initials: ML
authors.lastname: Sorror
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Rainer F
authors.initials: RF
authors.lastname: Storb
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Maziarz
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Maris
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Ostronoff
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Syrjala
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Elihu
authors.initials: E
authors.lastname: Estey
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: David G
authors.initials: DG
authors.lastname: Maloney
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, and Barry E. Storer, Fred Hutchinson Cancer Research Center; Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, and Paul J. Martin, University of Washington School of Medicine; Barry E. Storer, University of Washington School of Public Health, Seattle, WA; Smita Bhatia, City of Hope School of Medicine, Duarte, CA; Richard T. Maziarz, Center for Hematologic Malignancies, Oregon Health & Science University Knight Cancer Institute and School of Medicine, Portland, OR; Michael A. Pulsipher, University of Utah School of Medicine and Primary Children's Medical Center, Huntsman Cancer Institute, Salt Lake City, UT; and Michael B. Maris, Colorado Blood Cancer Institute School of Medicine, Denver, CO.
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003657:Decision Making; D005260:Female; D006305:Health Status Indicators; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome