Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences

Sorror, Mohamed L.; Giralt, Sergío; Sandmaier, Brenda M.; Lima, Marcos J.G. de; Shahjahan, Munir; Maloney, David G.; Deeg, H. Joachim; Appelbaum, Frederick R.; Storer, Barry E.; Storb, Rainer

doi:10.1182/blood-2007-06-096966

Cited by 310 publications

(220 citation statements)

References 54 publications

(54 reference statements)

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“…While older age has been widely used to exclude patients from transplantation, assessment of comorbid conditions as measured by the hematopoietic cell transplantationspecific comorbidity index may help estimate risk of treatment-related mortality following HSCT [15][16][17]. In the presence of significant comorbidities, the danger of transplantation is far greater than postremission chemotherapy and may exclude patients from HSCT.…”

Section: Clinical Application Of Hsctmentioning

confidence: 99%

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

Hamilton

Copelan

2012

STEM CELLS

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Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative option for patients with acute myeloid leukemia (AML). Our understanding of the biology of leukemic stem cells has continued to improve over the last decade and risk stratification using cytogenetics and molecular markers have improved our ability to select patients who would benefit from allogeneic transplantation. Results of HSCT have also improved substantitally, extending the potential application of allogeneic transplant to more patients. This review discusses the theoretical aspects of transplant, analyzes clinical results, and provides recommendations for the use of HSCT in AML. Further study of the biology of leukemic stem cells and the role for HSCT is necessary to optimize outcomes in AML patients.

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Section: Clinical Application Of Hsctmentioning

confidence: 99%

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

Hamilton

Copelan

2012

STEM CELLS

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“…11 Since its creation in 2005, the HCT-CI has been validated as a prognostic indicator for US-based patients requiring allogeneic HCT for both unselected hematologic diseases 12 and for acute myeloid leukemia in first remission. 13 Investigators from Japan 14 and the United Kingdom 15 have examined the prognostic power of the HCT-CI in patients undergoing allogeneic HCT with reduced-intensity conditioning regimens. Similar studies have not, to our knowledge, been performed in either ablative or reducedintensity conditioning HCT at a Canadian center.…”

Section: Introductionmentioning

confidence: 99%

Performance status, but not the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), predicts mortality at a Canadian transplant center

Guilfoyle

Demers

Bredeson

et al. 2008

Bone Marrow Transplant

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The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was developed at a single center to predict outcomes for allogeneic transplant recipients who have comorbidities. The HCT-CI has not been widely validated in unselected transplant recipients. We evaluated whether the HCT-CI and other readily available pretransplant variables predicted NRM and OS at a Canadian transplant center. Using a prospective cohort design, we analyzed consecutive adult allogeneic HCT recipients. Of 187 patients, HCT-CI risk was low in 22 (12%), intermediate in 50 (27%), high in 104 (55%) and undetermined in 11 (6%). Two-year OS was 45% (95% CI: 24-64%), 55% (95% CI: 40-68%) and 42% (95% CI: 32-51%) in the low, intermediate and high-risk HCT-CI groups, respectively. Two-year NRM was 36% (95% CI: 17-56%), 26% (95% CI: 15-39%) and 30% (95% CI: 22-39%) in the low, intermediate and high-risk HCT-CI groups, respectively. In multivariate analysis, the HCT-CI failed to predict OS or NRM. However, KPS of o90% at HCT was a strong predictor of NRM. In conclusion, the HCT-CI was not associated with NRM or OS. In contrast, KPS was an independent indicator of survival. International multi-center studies are required before the HCT-CI is used in clinical practice.

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“…7,8 Similar results were obtained when the Seattle data on AML patients in first CR was combined with data from the MD Anderson cancer center. 9 In data presented here, we find no statistically significant difference between HCT-CI (as stratified into 0, 1-2 and 43) in terms of OS or TRM. However, we do note that there is a trend toward improved OS in those patients without any comorbidities, in comparison to all other patients.…”

Section: Discussionmentioning

confidence: 55%

Comorbidity index does not predict outcome in allogeneic myeloablative transplants conditioned with fludarabine/i.v. busulfan (FluBu4)

Patel

Sweiss

Nimmagadda

et al. 2010

Bone Marrow Transplant

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The assessment of a hematopoietic stem cell transplant (HSCT)-specific comorbidity index (HCT-CI) has been developed to predict the risk of TRM in patients undergoing allogeneic HSCT. As the myeloablative fludarabine/i.v. busulfan (FluBu4) regimen has been associated with limited extra-hematologic toxicity, we analyzed whether the HCT-CI represents a useful tool in transplant patients conditioned with this regimen. Of the 52 consecutive patients who received an allogeneic HSCT with FluBu4 at our institution, 50 were evaluable for assessing pre-transplant HCT-CI. Patients were divided into three groups: score 0 (n ¼ 7); score 1-2 (n ¼ 17) and score 43 (n ¼ 26). The three groups did not differ significantly in age, diagnosis, previous lines of chemotherapy and type of donor. High-risk disease was present in 57% of low, 82% of intermediate and 85% of high HCT-CI score groups (P ¼ ns). Two-year TRM and OS was 14.3 and 85.7% in the low score group, 23.5 and 58.8% in the intermediate score group and 15.4 and 50% in the high HCT-CI score group (P ¼ ns). In this study, the HCT-CI lacked sensitivity to reliably predict TRM although patients with no comorbidities showed a trend for improved survival.

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Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences

Cited by 310 publications

References 54 publications

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

Performance status, but not the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), predicts mortality at a Canadian transplant center

Comorbidity index does not predict outcome in allogeneic myeloablative transplants conditioned with fludarabine/i.v. busulfan (FluBu4)

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