Patient‐reported physical functioning predicts the success of hematopoietic cell transplantation (BMT CTN 0902)

Abstract

BACKGROUND In hematopoietic cell transplantation (HCT), current risk adjustment strategies are based upon clinical and disease-related variables. Though patient reported outcomes (PROs) predict mortality in multiple cancers, PROs have been less well studied within HCT. Improvements in risk adjustment strategies in HCT would inform patient selection, patient counseling, and quality reporting. Our objective was to determine whether pre-HCT PROs, in particular physical health, predict survival among patients undergoing autologous or allogeneic transplantation. METHODS In this secondary analysis, we studied pre-HCT PROs that were reported by 336 allogeneic and 310 autologous HCT recipients enrolled in the BMT CTN 0902 trial, a study with broad representation of patients transplanted in the US. RESULTS Among allogeneic HCT recipients, the pre-HCT SF-36 physical component summary score (PCS) independently predicted overall mortality (HR 1.40 per 10 point decrease, p<0.001) and performed at least as well as currently used, non-PRO risk indices. Survival probability estimates at one year for the first, second, third, and fourth quartiles of the baseline PCS were 50%, 65%, 75%, and 83%. Early post-HCT decreases in PCS were associated with higher overall and treatment-related mortality. When adjusted for patient variables included in the US Stem Cell Therapeutic Outcomes Database model for transplant center-specific reporting, the SF-36 PCS retained independent prognostic value. CONCLUSIONS PROs have the potential to improve prognostication in HCT. We recommend the routine collection of PROs prior to HCT, and consideration of incorporation of PROs into risk adjustment for quality reporting.

Practice Patterns and Preferences Among Hematopoietic Cell Transplantation Clinicians

“…These calculators could integrate known risk indices, such as the HCT-CI, and emerging risk factors as these are identified, so that clinician estimates of efficacy or toxicity would vary appropriately based on the literature, rather than converging around similar estimates for most scenarios as we observed in the vignettes. If the CIBMTR incorporates patient-reported outcomes into routine data collection, these risk calculators could become even more relevant for patient counseling [16-18]. Of note, the CIBMTR currently has an online survival calculator for allogeneic HCT, using the center-specific survival analysis model to generate estimates for 1-year overall survival based on a set of user-inputted individual patient characteristics.…”

Patient-Reported Outcomes and Socioeconomic Status as Predictors of Clinical Outcomes after Hematopoietic Stem Cell Transplantation: A Study from the Blood and Marrow Transplant Clinical Trials Network 0902 Trial

“…Previous research has shown that baseline patient-reported outcome (PRO) and socioeconomic status (SES) measures predict morbidity and mortality following hematopoietic cell transplantation (HCT) [1–6]. In contrast to other cancer populations, there is minimal published research investigating more proximal clinical events or immunologic determinants to suggest candidate biobehavioral mechanisms that might explain this relationship [7,8].…”

Reprint of: Aging: Treating the Older Patient

“…Adverse effects were amplified in patients 60 and older (HR, 3.3) relative to patients 50 to 59 (HR, 1.9), although CIs overlapped. Patient function through a self-report quality of life instrument also conveyed worse 1-year survival rates in a multi-institutional study by Wood et al [80] of all ages supporting the premise of patientreported function for prognostication.…”