title: Reevaluation of the pretransplant assessment of mortality score after allogeneic hematopoietic transplantation.
abstract: The Pretransplant Assessment of Mortality (PAM) score was developed in 2006 to predict risk of mortality after allogeneic hematopoietic cell transplantation (HCT). Transplant practices have evolved during the past decade, suggesting the need to reevaluate the performance of the PAM score. We used statistical modeling to analyze and recalibrate mortality based on overall PAM scores, its components, and conditioning regimen in a retrospective cohort of 1549 patients who had HCT from 2003 through 2009. PAM scores correlated with mortality, but the effect size was smaller in the current study than in previous studies. PAM scores also demonstrated a stronger association with mortality in patients who received myeloablative conditioning than in those who received reduced-intensity conditioning. In contrast to the original study, carbon monoxide diffusing capacity, serum alanine aminotransferase, and serum creatinine concentrations were no longer significantly associated with 2-year mortality, whereas patient and donor cytomegalovirus serology was associated with mortality in the current cohort. Based on our findings, we developed and tested a revised PAM score for clinicians to estimate survival after allogeneic HCT with myeloablative conditioning regimens for patients with hematologic malignancy. Prognostic models such as the PAM score should be updated and recalibrated periodically to accommodate changes in clinical practice.
authors: Department of Medicine, University of Washington, Seattle, Washington.
authors: Brandon K C
authors: BK
authors: Au
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Ted A
authors: TA
authors: Gooley
authors: Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts.
authors: Philippe
authors: P
authors: Armand
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Min
authors: M
authors: Fang
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: David K
authors: DK
authors: Madtes
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: Mohamed L
authors: ML
authors: Sorror
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: Michael J
authors: MJ
authors: Boeckh
authors: Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
authors: Christopher J
authors: CJ
authors: Gibson
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: Hans Joachim
authors: HJ
authors: Deeg
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: Rainer
authors: R
authors: Storb
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington.
authors: Frederick R
authors: FR
authors: Appelbaum
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Jason W
authors: JW
authors: Chien
authors: Division of Clinical Research, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington. Electronic address: pmartin@fhcrc.org.
authors: Paul J
authors: PJ
authors: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D064591:Allografts; D002248:Carbon Monoxide / Q000097:blood; D002648:Child; D003404:Creatinine / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008954:Models, Biological; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning
chemical_list: D002248:Carbon Monoxide; D003404:Creatinine; D000410:Alanine Transaminase
keywords: Allogeneic hematopoietic cell transplantation; Comorbidity; Risk assessment; Survival
references: Blood. 2001 Jun 1;97(11):3390-400
references: 11369628
references: Blood. 2004 Sep 1;104(5):1258-65
references: 15126323
references: Am Rev Respir Dis. 1981 Feb;123(2):185-9
references: 7235357
references: Am Rev Respir Dis. 1981 Jun;123(6):659-64
references: 7271065
references: Am Rev Respir Dis. 1991 Nov;144(5):1202-18
references: 1952453
references: Am J Respir Crit Care Med. 1995 Sep;152(3):1107-36
references: 7663792
references: Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):2185-98
references: 8520796
references: Blood. 1997 Mar 15;89(6):2079-88
references: 9058730
references: Comput Methods Programs Biomed. 1997 Nov;54(3):201-8
references: 9421665
references: Blood. 2005 Oct 15;106(8):2912-9
references: 15994282
references: Ann Intern Med. 2006 Mar 21;144(6):407-14
references: 16549853
references: Blood. 2007 Mar 1;109(5):1857-61
references: 17105812
references: Blood. 2008 Jan 15;111(2):558-65
references: 17962512
references: Biol Blood Marrow Transplant. 2008 Sep;14(9):1039-44
references: 18721767
references: Leukemia. 2008 Nov;22(11):2062-9
references: 18685612
references: Biol Blood Marrow Transplant. 2010 Mar;16(3):413-20
references: 19922807
references: N Engl J Med. 2010 Nov 25;363(22):2091-101
references: 21105791
references: Bone Marrow Transplant. 2011 Jul;46(7):1000-5
references: 20921945
references: Blood. 2012 Jul 26;120(4):905-13
references: 22709687
references: Bone Marrow Transplant. 2012 Aug;47(8):1075-81
references: 22101199
references: Blood. 2012 Aug 16;120(7):1398-408
references: 22767498
references: Blood. 2013 Apr 11;121(15):2854-63
references: 23355537
references: J Clin Oncol. 2013 Apr 20;31(12):1530-8
references: 23478054
references: Clin Infect Dis. 2014 Aug 15;59(4):473-81
references: 24850801
references: Biol Blood Marrow Transplant. 2014 Sep;20(9):1455-6
references: 24813169
references: J Clin Oncol. 2014 Oct 10;32(29):3249-56
references: 25154831