Impact of comorbidities constituting the hematopoietic cell transplant (HCT)‐comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia

Khalil, Manar; Lipton, Jeffrey H.; Atenafu, Eshetu G.; Gupta, Vikas; Kim, Dennis Dong Hwan; Kuruvilla, John; Viswabandya, Auro; Messner, Hans A.; Michelis, Fotios V.

doi:10.1111/ejh.13000

Cited by 19 publications

(15 citation statements)

References 31 publications

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“…The recent EBMT cohort contains a higher frequency of dose-reduced conditioning (52% vs. 28% original HCT-CI cohort), unrelated donors (64% vs. 42%), and older patients (median age 53.3 vs. 44.8 years) as compared to the original HCT-CI cohort. Over the last few decades, considerable progress has been made regarding the reduction of NRM, which is most likely due to progress in intensive care medicine, as well as to improved management of GVHD, conditioning regimens, and prevention/treatment of infectious complications in alloSCT recipients [ 5 , 9 , 11 – 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

Penack

Peczynski

Mohty

et al. 2021

Bone Marrow Transplant

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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.

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Section: Discussionmentioning

confidence: 99%

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

Penack

Peczynski

Mohty

et al. 2021

Bone Marrow Transplant

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“…The Framingham general CV risk score has also shown increased CV risk in male survivors [96]. Interestingly, diabetes and CV comorbidity as derived by the HCT comorbidity index independently predicted nonrelapse mortality in a recent study [97].…”

Section: Cardiovascular Risk Prediction Modelsmentioning

confidence: 95%

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

Gavriilaki

Gkaliagkousi

Sakellari

et al. 2019

Biology of Blood and Marrow Transplantation

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Cardiovascular (CV) events have emerged as a major cause of morbidity and mortality among hematopoietic cell transplantation (HCT) survivors. Accumulating evidence supports the presence of increased CV risk in HCT recipients. Most studies have focused mainly on traditional CV risk factors, such as the metabolic syndrome and hypertension. However, detection of these factors suggests the development of irreversible overt clinical atherosclerosis. Therefore, earlier prediction of CV risk is needed to prevent CV morbidity and mortality in these patients. In the field of CV research, endothelial dysfunction is considered an early event in the pathophysiology of CV risk factors, and a number of markers have been proposed for its assessment. In addition, markers of subclinical target organ damage have been introduced to implement CV risk prediction and early preventive or intensive therapeutic interventions. Furthermore, a number of CV models have been suggested aiming for optimal stratification of patients. Preliminary studies have indicated excess CV risk using these early markers in HCT recipients. However, their role in the pathophysiology and clinical practice in HCT survivors remains largely understudied. Taking into account the need for increased awareness from treating physicians in this evolving setting, we conducted a state-of-the-art review aiming to summarize current knowledge on endothelial dysfunction, subclinical target organ damage, and CV risk prediction in HCT survivors.

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“…Similarly, Fein et al demonstrated that certain comorbidities were associated with an increased risk of TRM when particular conditioning regimens were chosen, while the impact of a high HCT‐CI score was also regimen specific . Another recent study in patients with acute myeloid leukemia showed that particular pretransplant comorbidities had a disproportionate effect on outcomes compared to what would have been expected based on the HCT‐CI score . These reports support that the presence of certain risk factors may lead to regimen‐specific toxicity, and therefore early recognition of these comorbidities may allow providers to tailor conditioning regimens for individual patients in the hopes of improving outcomes.…”

Section: Discussionmentioning

confidence: 84%

Identifying risk factors associated with worse outcomes in adolescents and young adults undergoing hematopoietic stem cell transplantation

Friend

Tang

Markovic

et al. 2019

Pediatric Blood & Cancer

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Background Adolescents and young adults (AYAs) undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have unique risk factors and poor outcomes when compared to children, but this population has not been well studied. A hematopoietic stem cell transplantation‐comorbidity index (HCT‐CI) has been developed in adults to help predict outcomes, yet this index does not seem suitable for a younger population. Therefore, we sought to examine the prevalence of various risk factors in AYAs undergoing allogeneic HSCT and determine which factors had the greatest impact on overall survival (OS) and treatment‐related mortality (TRM). Procedures This was accomplished by retrospectively collecting data on 241 patients who received their first allogeneic HSCT at UCLA between 2005 and 2015. We investigated the effect of multiple predictors using the Cox proportional hazards model and Fine and Gray competing risk model for OS and TRM, respectively. Results Our results showed that AYAs undergoing allogeneic HSCT had poor outcomes, with 5‐year OS and NRM of 48% and 30%, respectively. We demonstrated that compared to a baseline model, the addition of the HCT‐CI did not improve its ability to predict OS, while substituting individual comorbidities, that is, an unweighted comorbidity score, resulted in significant improvement in model performance. The factors associated with inferior outcomes were used to develop an AYA‐specific risk score. Conclusions The comorbidities included in the HCT‐CI as well as additional risk factors seen in younger populations need to be studied in prospective studies with the goal of validating and refining a risk score specific to AYA patients undergoing allogeneic HSCT.

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Impact of comorbidities constituting the hematopoietic cell transplant (HCT)‐comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia

Abstract: Among the comorbidities that compose the HCT-CI, diabetes and cardiovascular comorbidity independently predict NRM in patients undergoing allogeneic HCT for AML. This information should be taken into consideration regarding post-transplant monitoring and care.

Cited by 19 publications

References 31 publications

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

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

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

Identifying risk factors associated with worse outcomes in adolescents and young adults undergoing hematopoietic stem cell transplantation

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