Hematopoietic cell transplantation (HCT)-specific-comorbidity index: A new tool for risk assessment before allogeneic HCT

Sorror, Mohamed L.; Maris, Michael B.; Storb, Rainer; Baron, Frédéric; Sandmaier, Brenda M.; Maloney, David G.; Barry, Sarah

doi:10.1016/j.bbmt.2004.12.067

Cited by 633 publications

(941 citation statements)

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“…The potentially higher incidence of relapse is offset by lower treatment-related mortality (TRM) (Alyea et al 2006;Martino et al 2006;Oliansky et al 2009;Warlick et al 2009). However, results from retrospective studies must be interpreted with caution, because of likely bias in patient selection (Martino et al 2006;Sorror et al 2004Sorror et al , 2005. No prospective randomized study has been conducted; a CTN sponsored phase III trial is currently getting underway in the USA (CTN #0901).…”

Section: Conditioning Regimensmentioning

confidence: 99%

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Deeg

Bartenstein

2011

Arch. Immunol. Ther. Exp.

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Hematopoietic cell transplantation (HCT) offers potentially curative therapy for patients with myelodysplastic syndrome (MDS). However, as the majority of patients with MDS is in the 7th or 8th decade of life, only few of these patients were transplanted following high-dose conditioning regimens. The development of reduced-intensity conditioning has allowed to apply HCT also to older patients and those with clinically relevant comorbid conditions. Dependent upon disease status and the type of clonal chromosomal abnormalities present at the time of HCT, some 25-75% of patients will be cured of their disease and survive long term. Recent results with HLA-matched unrelated donors are comparable to those with HLA genotypically identical siblings. The increasing use of cord blood and HLA-haploidentical donors is expected to make HCT available to a growing number of patients. However, post-transplant relapse and graft-versus-host disease remain problems requiring further instigations.

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Section: Conditioning Regimensmentioning

confidence: 99%

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Deeg

Bartenstein

2011

Arch. Immunol. Ther. Exp.

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“…The projected relapse-free survival at 4 years was 41%, with the lead patient surviving at more than 14 years; outcome with related and unrelated donors was comparable. The major risk factors for mortality after HCT were pre--transplant comorbidities as described by Sorror and colleagues [14,27]. Patients with a comorbidity score of 2 or less showed a survival of 54%, compared with 15% in patients with a score of 3 or higher.…”

Section: Autologous Hctmentioning

confidence: 99%

Hematopoietic cell transplantation for chronic myeloproliferative disorders

Tse

Deeg

2006

Arch. Immunol. Ther. Exp.

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Myeloproliferative disorders, including chronic idiopathic myelofibrosis (CIMF), polycythemia vera (PV), essential thrombocythemia (ET), and chronic myelomonocytic leukemia (CMML), are clonal diseases of hematopoietic stem or precursor cells. They often show a protracted or chronic course; however, all have the potential of progressing to severe marrow failure, associated with myelofibrosis, or of transforming into acute leukemia. At that point, hematopoietic cell transplantation (HCT) is the only current treatment strategy with curative potential. If transplantation is being considered and a suitable donor is available, HCT should be carried out before leukemic transformation has occurred, as the success rate of HCT declines steeply in patients who have evolved to leukemia. As many as 75-80% of patients with the original diagnoses of PV or ET, about 65-70% with CIMF, and 45% of patients with CMML are surviving long term after allogeneic HCT using conventional transplant regimens, with follow-up now extending to 15 years. Results with HLA-identical related and unrelated donors are comparable. Major risk factors for the outcome after HCT are the disease stage, the presence of comorbid conditions, and patient age. The development of reduced-intensity conditioning regimens has allowed for successful HCT even for older patients and patients with comorbid conditions. Studies on disease mechanisms, including the recent characterization of an activating mutation in JAK2, may provide additional prognostic guidance and are likely to lead to the development of novel treatment strategies, which will require continuous reassessment as to the optimum timing of HCT.

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“…We speculate that the association of NRM with higher HCT-CI scores may be explained in part by the development of serious GVHD. 31,39 Because the NMA cohort was older and had higher HCT-CI than those in the MA group, one might have expected a higher incidence of serious GVHD in the NMA than in MA group, because patients with severe comorbidity and impaired organ reserve in the lungs, liver, kidneys or heart are likely to be less able to tolerate severe GVHD and the toxicity of immunosuppressive treatment. Nonetheless, in the current study, the incidence of serious GVHD before relapse or progression of hematological malignancy was similar (14 versus 21%) after MA and NMA conditioning regimens, respectively.…”

Section: Tablementioning

confidence: 99%

“…We have previously reported that HCT-CI is a predictor for NRM after MA and NMA conditioning regimens. 31,39 HCT-CI is also a predictor for grades III-IV acute GVHD after MA conditioning. 40 In the current study, death was the most common reason for serious GVHD in both groups.…”

Section: Tablementioning

confidence: 99%

“…30 Univariate proportional hazards models were used to evaluate risk factors for serious GVHD, treating deaths not related to GVHD as competing events. Risk factors that were tested in this analysis included patient's age, comorbidities as assessed by HCT-comorbidity index (HCT-CI), 31 donor type, donor-recipient gender pair, diagnosis at transplant, disease status (aggressive versus indolent), myeloid malignancies versus nonmyeloid malignancies, DLI before development of serious GVHD and number of cells infused per kilogram patient body weight (CD34, CD3 and total nucleated cells). All P-values were based on likelihood ratio statistics and were two sided.…”

Section: Statisticsmentioning

confidence: 99%

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Serious acute or chronic graft-versus-host disease after hematopoietic cell transplantation: a comparison of myeloablative and nonmyeloablative conditioning regimens

Sala‐Torra

Petřek

Storer

et al. 2008

Bone Marrow Transplant

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We previously reported a 25% incidence of serious graftversus-host disease (GVHD) (that is, acute or chronic GVHD that caused death, lengthy hospitalization or disability, or resulted in recurrent major infections) among 171 hematopoietic cell transplantation (HCT) recipients after nonmyeloablative (NMA) regimen. Here we present a retrospective study applying the same criteria to 264 recipients of peripheral blood HCT after myeloablative (MA) regimen, and compare the results with the previous study after additional follow-up. The MA group was younger and had lower comorbidity scores at HCT than those in the NMA group. The overall incidence of serious GVHD was 17% (44/264) in the MA group versus 28% (48/171) in the NMA group. The adjusted hazard ratio (HR) of serious GVHD in the MA group compared to the NMA group was 0.65 (95% CI, 0.4-1.1); P ¼ 0.13, and if follow-up was censored at the onset of recurrent or progressive malignancy, HR was 0.67 (95% CI, 0.4-1.3), P ¼ 0.22. We conclude that the choice between MA and NMA regimens does not greatly affect the risk of serious GVHD as an overall indicator of outcomes related to either acute or chronic GVHD. Serious GVHD may be considered as an endpoint in clinical trials with GVHDrelated outcomes.

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Hematopoietic cell transplantation (HCT)-specific-comorbidity index: A new tool for risk assessment before allogeneic HCT

Cited by 633 publications

References 0 publications

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Hematopoietic cell transplantation for chronic myeloproliferative disorders

Serious acute or chronic graft-versus-host disease after hematopoietic cell transplantation: a comparison of myeloablative and nonmyeloablative conditioning regimens

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