Faculty Collaboration Database

Optimal Donor Selection for Hematopoietic Cell Transplantation Using Bayesian Machine Learning. JCO Clin Cancer Inform 2021 May;5:494-507

Date

05/06/2021

Pubmed ID

33950708

Pubmed Central ID

PMC8443829

DOI

10.1200/CCI.20.00185

Scopus ID

2-s2.0-85105478562 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

PURPOSE: Donor selection practices for matched unrelated donor (MUD) hematopoietic cell transplantation (HCT) vary, and the impact of optimizing donor selection in a patient-specific way using modern machine learning (ML) models has not been studied.

METHODS: We trained a Bayesian ML model in 10,318 patients who underwent MUD HCT from 1999 to 2014 to provide patient- and donor-specific predictions of clinically severe (grade 3 or 4) acute graft-versus-host disease or death by day 180. The model was validated in 3,501 patients from 2015 to 2016 with archived records of potential donors at search. Donor selection optimizing predicted outcomes was implemented over either an unlimited donor pool or the donors in the search archives. Posterior mean differences in outcomes from optimal donor selection versus actual practice were summarized per patient and across the population with 95% intervals.

RESULTS: Event rates were 33% (training) and 37% (validation). Among donor features, only age affected outcomes, with the effect consistent regardless of patient features. The median (interquartile range) difference in age between the youngest donor at search and the selected donor was 6 (1-10) years, whereas the number of donors per patient younger than the selected donor was 6 (1-36). Fourteen percent of the validation data set had an approximate 5% absolute reduction in event rates from selecting the youngest donor at search versus the actual donor used, leading to an absolute population reduction of 1% (95% interval, 0 to 3).

CONCLUSION: We confirmed the singular importance of selecting the youngest available MUD, irrespective of patient features, identified potential for improved HCT outcomes by selecting a younger MUD, and demonstrated use of novel ML models transferable to optimize other complex treatment decisions in a patient-specific way.

Author List

Logan BR, Maiers MJ, Sparapani RA, Laud PW, Spellman SR, McCulloch RE, Shaw BE

Authors

Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Brent R. Logan PhD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin
Rodney Sparapani PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Bayes Theorem
Child
Donor Selection
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Machine Learning