Quality of life (QOL) is an important outcome for hematopoietic cell transplantation (HCT) recipients. Whether pre-HCT QOL adds prognostic information to patient and disease related risk factors has not been well described. We investigated the association of pre-HCT QOL with relapse, non-relapse mortality (NRM), and overall mortality after allogeneic HCT. From 2003 to 2012, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale instrument was administered before transplantation to 409 first allogeneic HCT recipients. We examined the association of the three outcomes with (1) individual QOL domains, (2) trial outcome index (TOI) and (3) total score. In multivariable models with individual domains, functional well-being (hazard ratio (HR) 0.95, P = 0.025) and additional concerns (HR 1.39, P = 0.002) were associated with reduced risk of relapse, no domain was associated with NRM, and better physical well-being was associated with reduced risk of overall mortality (HR 0.97, P = 0.04). TOI was not associated with relapse or NRM but was associated with reduced risk of overall mortality (HR 0.93, P = 0.05). Total score was not associated with any of the three outcomes. HCT-comorbidity index score was prognostic for greater risk of relapse and mortality but not NRM. QOL assessments, particularly physical functioning and functional well-being, may provide independent prognostic information beyond standard clinical measures in allogeneic HCT recipients. Despite advances in transplantation techniques and supportive care, the morbidity and mortality related to this intensive treatment remain high. Many factors predict survival outcomes after allogeneic HCT, including patient age, comorbidities, donor source, performance status, diagnoses, disease status, and carepartner support. Although several studies have investigated and described QOL after transplantation, including the trajectory of QOL risk factors for QOL impairments and interventions to improve QOL, 13-20 the association of pre-transplantation QOL with recovery and survival after allogeneic HCT has not been well described. We hypothesized that QOL measures before HCT may add to the prognostic information provided by known clinical factors among allogeneic HCT recipients. We therefore undertook this analysis to determine the prognostic impact of pre-transplant QOL scores, as captured by the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), on post-HCT non-relapse mortality (NRM) and overall mortality.

7102 Background: Sorror et al. has identified HCT-CI as a valid scoring of pretransplant comorbidities that predicted nonrelapse mortality and survival after allogeniec HCT. We recently reported on the validity of HCT-CI in predicting morbidity outcomes after AHCT for lymphoma (BBMT in press). High HCT-CI score predicted for prolonged hospitalization and high incidence of hospital re-admission after AHCT. The objective of this study is to evaluate the impact of HCT-CI on mortality risk after AHCT. Methods: We included pts above age of 40 with advanced HL or NHL, who underwent AHCT in our institution between 01/98 & 05/06. Median follow up was 29.4 mo. Pts were assigned scores based on the HCT-CI. Defenition of comorbidities were recently reported (Kassar et al, BBMT in press). Results: 80 pts were included (NHL: 74, HL: 6). 61 pts were male. Median age was 56 years (42–76). Comorbidities (points, prevalence%): mild hepatic (1,14), cardiac (1,15), cerebrovascular (1,4), arrhythmia (1,9), moderate pulmonary (2,11), severe pulmonary (3,8), rheumatologic (2,5), DM (1,23), inflammatory bowel disease (1,3), psychiatric (1,11), infection (1,6), obesity (1,11), and renal (2,1). Median HCT-CI was 1 (0: 37 %, 1: 26%, 2–7: 37%). 22 pts died: 15 from relapse and 7 from non relapse mortality (NRM) causes. Cumulative day-100 NRM and 1-year NRM rates are: 1.3% and 4%, respectively. Pts were categorized into 2 groups: low-risk (scores of 0–1) and high-risk (scores 2–7). Using Cox Regression model and adjusting for age and histology, low-risk group had a significantly better OS (1 wk-58.6 mo, median 34.1 mo) compared to high-risk group (5 days-23.6 mo, median 6 mo) (HR: 3.73, p = .01, 95% CI 1.32, 10.54). 1-year OS rate was 75% vs. 25%, respectively (p=.04). Conclusion: HCT-CI is a valid scoring of pre-transplant comorbidities that predicted mortality after AHCT for pts with lymphoma. The physiologic burden of comorbidities is likely to impact the tolerance to AHCT or to other therapies administered upon relapse after transplant. HCT-CI can serve as important tool for both the transplant administrator when planning for resources allocation and clinical trials, and for pts during pre-transplant evaluation and counseling. No significant financial relationships to disclose.

Background: For all “transplant eligible” pts with MM, established practice guidelines recommend ASCT as part of the front line treatment. However, the definition of “transplant eligible” remains undefined. The HCT-CI is a new tool that encapsulates pre-transplant comorbidities used in predicting transplant outcomes in pts undergoing allogeneic SCT. This scoring system has been shown to be a good predictor for non-relapse mortality (NRM) & survival in pts undergoing alloSCT. In this study, we hypothesize that HCT-CI could predict the transplant outcome on pts with MM undergoing ASCT and could potentially be utilized as a tool for selecting pts with MM for transplant. Methods: A retrospective analysis of 75 pts with multiple myeloma whom underwent ASCT in our institution between 02/99 and 12/03 with a median follow up of 30 months. Pts were assigned scores based on the HCT-CI. Definitions of comorbidities were as previously reported by Sorror et. al. (Blood2005; 106:2912). Results: Median age was 56 years (38 – 73); M:F 1:1. 51 pts received a single & 24 had tandem ASCT. The majority of pt. had IgG myeloma (IgG kappa: 45; IgG Lambda 17). Comorbidities (points, number of pts): mild hepatic (1,16), renal (2,6), cardiac (1,8), arrhythmia (1,1), heart valve disease (3,4), cerebrovascular (1,8), DM (1,11), PUD (2,2), inflammatory bowel disease (1,0), Tumor (3,6), pulmonary (2,5), psychiatric (1,8), rheumatologic (2,3), infection (1,6), and obesity (1,10). HCT-CI score of 0 seen in 32%, 1 in 28%, 2–8 in 40% of the pts, with a median score of 1.65. 20 patients died with only one due to NRM. Pts were categorized into 2 groups: low-risk (scores of 0–1) – 46 pts and high-risk (scores 2–8) – 29. Using a cox regression model, the low risk group had a survival advantage (HR = 2.55, P = 0.04). Using Kaplan Meier survival estimate comparing the low risk and high risk group (figure1), the 5 yrs overall survival were 77% & 22% respectively (P = 0.04). While the median survival for the high risk group was 3.52 years, it has not been reached for the low risk group. Conclusion: Here, we have demonstrated a survival benefit for pts with low (0–1) compared with high (≥ 2) HCT-CI score. In addition, the outcome of pts with high HCT-CI score was also similar to non-transplant pts as published in the literature. This raises the question of “benefit” of ASCT for pts with high HCT-CI score. Thus, HCT-CI may serve as a useful tool to select pts whom would benefit most from ASCT. Figure 1 Figure 1