Validation of the acute leukemia-EBMT score for prediction of mortality following allogeneic stem cell transplantation in a multi-center GITMO cohort.
Predictive models may help in determining the risk/benefit ratio of allogeneic hematopoietic stem cell transplantation (HSCT) in acute leukemia (AL). Using a machine-learning algorithm we have previously developed the AL- European Society for Blood and Marrow Transplantation (EBMT) score for prediction of mortality following transplantation. We report here the first external validation of the AL-EBMT score in a cohort of AL patients from the Italian national transplantation network. A total of 1848 patients transplanted between the years 2000-2014 were analyzed. The median age was 45.9. Indications for HSCT were Acute Myeloid Leukemia (68.1%) and Acute Lymphoblastic Leukemia (31.9%). The majority of patients were in first complete remission (60.4%), and received myeloablative conditioning (81.3%). Median follow-up was 2 years. The score was well-calibrated for prediction of day 100 mortality and 2-year overall survival (OS), leukemia free survival (LFS), and nonrelapse related mortality, with corresponding area under the receiver-operator curves of 0.698, 0.651, 0.653, and 0.651, respectively. Increasing score intervals were associated with a decreasing probability of 2-year OS and LFS. The highest scoring group was associated with a hazard ratio of 3.16, 2.8, and 2.27 for 2-year OS, LFS, and NRM, respectively. In conclusion, the AL-EBMT score identified three distinct risk groups and was predictive of OS. It is a valid tool for stratifying the risk of acute leukemia patients undergoing allogeneic HSCT.
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler School of Medicine, Tel-Aviv University, Israel.|Bar-Ilan University, Ramat Gan, Israel.
Roni
http://orcid.org/0000-0001-9827-8032
R
Shouval
S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
Francesca
F
Bonifazi
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler School of Medicine, Tel-Aviv University, Israel.
Joshua
J
Fein
Hematology and BMT Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Cristina
C
Boschini
Hematology and BMT Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Elena
E
Oldani
Acute Leukemia Working Party-Paris Office, Hospital Saint-Antoine, EBMT, Paris, France.
Myriam
M
Labopin
Hematology and BMT Unit, Ospedale San Bortolo, Vicenza, Italy.
Roberto
R
Raimondi
Italian Bone Marrow Donor Registry E.O. Galliera-Genova, Italy.
Nicoletta
N
Sacchi
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Osamah
O
Dabash
Bar-Ilan University, Ramat Gan, Israel.
Ron
R
Unger
Hematology Department, Saint-Antoine Hospital, AP-HP, Universite Pierre et Marie Curie, Paris, France.
Mohamad
M
Mohty
Hematology and BMT Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Alessandro
A
Rambaldi
Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel.|Sackler School of Medicine, Tel-Aviv University, Israel.
Arnon
A
Nagler
D000208:Acute Disease; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007558:Italy; D007938:Leukemia / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D016019:Survival Analysis; D014184:Transplantation, Homologous