Hematopoietic cell transplantation comorbidity index and risk of developing invasive fungal infections after allografting

Abstract

We evaluated the potential correlation of the hematopoietic cell transplantation comorbidity index (HCT-CI) with the risk of developing post-transplant invasive fungal infections (IFIs). Between January 2009 and March 2015, 312 consecutive patients who received a first allograft entered the study. Low/intermediate HCT-CI risk score (0-2) was observed in 172/312 (55%), whereas high HCT-CI score (≥3) was seen in 140/312 (45%). Overall, 51/312 (16%) patients experienced IFI, defined as possible in 19 (6%), probable in 27 (9%), and proven in 5 (2%). Cumulative incidence of probable-proven IFI at 1 year was 8.5% with a significant higher incidence in patients with high HCT-CI (12%) vs. those with low-intermediate HCT-CI (5%; p = 0.006). There was a strong trend for a higher incidence of baseline severe pulmonary comorbidity in patients who developed probable-proven IFI (p = 0.051). One-year cumulative incidence of non-relapse mortality was higher in patients with IFI vs. those without, 49 and 16% (p < 0.001). By multivariate analysis, disease status at transplant and high HCT-CI, when combined with acute GVHD, were independently associated with the risk of post-transplant IFI. This study shows that a high HCT-CI predicts the risk of developing IFI and may indicate the need of mold-active antifungal prophylaxis in high-risk patients.

Association between the kinetics of cytomegalovirus reactivation evaluated in terms of the area under the curve of cytomegalovirus antigenemia and invasive mold infection during the post‐engraftment phase after allogeneic hematopoietic stem cell transplantation

“…Neutropenia lasting ≥1 week was also evaluated. Hematopoietic cell transplantation‐specific comorbidity index (HCT‐CI) was calculated as previously reported 34 . We did not evaluate the amount of red blood cell transfusion before HSCT or the ferritin level because of a significant number of missing data.…”

Impact of neutropenia evaluated in terms of the D‐index on invasive fungal disease while on empiric or preemptive antifungal treatment strategy in the early phase after allogeneic hematopoietic stem cell transplantation

“…Performance status (PS) was evaluated based on the Eastern Cooperative Oncology Group (ECOG) scoring system. The hematopoietic cell transplantation‐specific comorbidity index (HCT‐CI) was calculated as previously reported 20 . We did not evaluate the amount of red blood cell transfusion before HSCT or the ferritin level because of a significant number of missing data.…”

“…The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was calculated as previously reported. 20 We did not evaluate the amount of red blood cell transfusion before HSCT or the ferritin level because of a significant number of missing data. Corticosteroid usage at ≥0.5 mg per patient's body weight of prednisolone or equivalent was regarded as positive when it was started in the early phase after HSCT.…”

Development and Applications of Prognostic Risk Models in the Management of Invasive Mold Disease

“…In 2005, Sorror et al [92] introduced the hematopoietic stem cell transplantation-comorbidity index (HSCT-CI) assessed prior to transplantation as a means of predicting non-relapse mortality, that was later updated with additional clinical risk factors [93]. Busca et al recently explored whether the HSCT-CI could have similar utility in predicting the risk for adult patients undergoing allogeneic HSCT for developing fatal IMD [94]. Among 360 retrospectively-analyzed patients who underwent allogeneic HSCT, 8.5% of patients developed EORTC/MSG probable or proven IMD that was significantly higher among patients with and HSCT-CI score of ≥3 (12%) compared to patients with HSCT-CI scores of 0–2 (5%).…”