Association of pre-existing comorbidities with outcome of allogeneic hematopoietic cell transplantation. A retrospective analysis from the EBMT

Abstract

Risk assessment of allogeneic hematopoietic cell transplantation (allo-HCT) is hindered by the lack of current data on comorbidities and outcome. The EBMT identified 38,760 allo-HCT recipients with hematologic malignancies transplanted between 2010 and 2018 from matched sibling and unrelated donors with a full data set of pre-existing comorbidities. Multivariate analyses using the Cox proportional-hazards model including known risk factors for non-relapse mortality (NRM) were performed. We found that pre-existing renal comorbidity had the strongest association with NRM (hazard ratio [HR] 1.85 [95% CI 1.55–2.19]). In addition, the association of multiple pre-existing comorbidities with NRM was significant, including diabetes, infections, cardiac comorbidity, and pulmonary comorbidity. However, the HR of the association of these comorbidities with NRM was relatively low and did not exceed 1.24. Consequently, the risk of NRM was only moderately increased in patients with a high hematopoietic cell transplantation comorbidity index (HCT-CI) ≥ 3 (HR 1.34 [1.26–1.42]). In the current EBMT population, pre-existing non-renal comorbidities determined NRM after allo-HCT to a much lesser extent as compared with the underlying HCT-CI data. Improvements in management and supportive care as well as higher awareness based on the use of HCT-CI may have contributed to this favorable development.

Comorbidities in transplant recipients with acute myeloid leukemia receiving low-intensity conditioning regimens: an ALWP EBMT study

“…Moreover, some prevalent comorbidities appeared to have limited independent contribution to the risk of NRM in the contemporary transplantation setting. 8,11 Older or more frail patients undergoing HSCT are generally treated using conditioning regimens designed to reduce the risk of treatment-related morbidity and mortality. Historically, regimens have been categorized as either "myeloablative" or "reduced intensity"/"non-myeloablative" based on the degree of bone marrow suppression they induce.…”

Pulmonary function is a strong predictor of 2‐year overall survival and non‐relapse mortality after allogenic hematopoietic cell transplantation

“…In the case that organ specific comorbidity could be an indicator of a patient's general physiological condition, it is interesting that in a recent study of 38 760 patients, Penack et al found that preexisting renal comorbidity had the strongest association with NRM. 20 We find that our study has several strengths adding value to our results, including the size of our population, the use of data from recently treated patients, the assessment of both OS and NRM, and creating a distinct division to the two subgroups comprising MAC or NMA patients in our study.…”

“…In the case that organ specific comorbidity could be an indicator of a patient's general physiological condition, it is interesting that in a recent study of 38 760 patients, Penack et al found that pre‐existing renal comorbidity had the strongest association with NRM. 20 …”

Association of individual comorbidities with outcomes in allogeneic hematopoietic cell transplantation from unrelated adult donors versus unrelated cord blood: A study on behalf of the Donor/Source and Transplant Complications Working Groups of the Japanese Society for Transplantation and Cellular Therapy

“…Infection also had a significant impact on NRM and OS in both unrelated donor recipient groups, which is consistent with previous studies. 2,3 In general practice, most physicians would prefer to select unrelated adult donors rather than UCB among patients with carryover infection before HCT.…”

“…1 However, several recent reports have shown that renal comorbidity had the strongest impact on NRM compared to other comorbidities and organ damage. [2][3][4][5] NRM in allogeneic HCT might be dependent on patient age, comorbidities, organ damage, conditioning intensity, and donor type.…”