Faculty Collaboration Database

The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases. Blood 2019 02 14;133(7):754-762

Date

12/14/2018

Pubmed ID

30545834

Pubmed Central ID

PMC6376282

DOI

10.1182/blood-2018-09-876284

Scopus ID

2-s2.0-85061488564   11 Citations

Abstract

Despite improvements, mortality after allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases remains a significant problem. We evaluated whether pre-HCT conditions defined by the HCT Comorbidity Index (HCT-CI) predict probability of posttransplant survival. Using the Center for International Blood and Marrow Transplant Research database, we identified 4083 patients with nonmalignant diseases transplanted between 2007 and 2014. Primary outcome was overall survival (OS) using the Kaplan-Meier method. Hazard ratios (HRs) were estimated by multivariable Cox regression models. Increasing HCT-CI scores translated to decreased 2-year OS of 82.7%, 80.3%, 74%, and 55.8% for patients with HCT-CI scores of 0, 1 to 2, 3 to 4, and ≥5, respectively, regardless of conditioning intensity. HCT-CI scores of 1 to 2 did not differ relative to scores of 0 (HR, 1.12 [95% CI, 0.93-1.34]), but HCT-CI of 3 to 4 and ≥5 posed significantly greater risks of mortality (HR, 1.33 [95% CI, 1.09-1.63]; and HR, 2.31 [95% CI, 1.79-2.96], respectively). The effect of HCT-CI differed by disease indication. Patients with acquired aplastic anemia, primary immune deficiencies, and congenital bone marrow failure syndromes with scores ≥3 had increased risk of death after HCT. However, higher HCT-CI scores among hemoglobinopathy patients did not increase mortality risk. In conclusion, this is the largest study to date reporting on patients with nonmalignant diseases demonstrating HCT-CI scores ≥3 that had inferior survival after HCT, except for patients with hemoglobinopathies. Our findings suggest that using the HCT-CI score, in addition to disease-specific factors, could be useful when developing treatment plans for nonmalignant diseases.

Author List

Thakar MS, Broglie L, Logan B, Artz A, Bunin N, Burroughs LM, Fretham C, Jacobsohn DA, Loren AW, Kurtzberg J, Martinez CA, Mineishi S, Nelson AS, Woolfrey A, Pasquini MC, Sorror ML

Authors

Larisa Broglie MD Assistant Professor in the Pediatrics 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
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin

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

Adolescent
Adult
Anemia, Aplastic
Autoimmune Diseases
Bone Marrow Diseases
Child
Child, Preschool
Comorbidity
Female
Follow-Up Studies
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hemoglobinuria, Paroxysmal
Humans
Infant
Infant, Newborn
Male
Metabolic Diseases
Prognosis
Prospective Studies
Survival Rate
Transplantation Conditioning
Transplantation, Homologous
Young Adult