Validation of the predictive power of the hematopoietic cell transplantation co-morbidity index, performance status for non-relapse mortality and long-term survival after autologous transplantation in patients with hematological malignancies

Journal
Bone Marrow Transplatation Journal
Date Issued
2010
Author(s)
DOI
10.1038/bmt.2010.41
Abstract
The hematopoietic cell transplantation comobrbidity index (HCTCI)
was developed as a sensitive tool to capture pretransplant
comorbidities among transplant recipients which will have infl uence
on non relapse mortality (NRM) and overall posttransplant
survival (OS). HCT-CI has not been widely validated among
autologous recepients. We retrospectivelly evaluated if HCT-CI
and karnofsky performance status (PS) and other readily available
pretransplant variables concerning pretransplant mobilization
strategies can predict the outcome of autologous recipients
in our transplant center.
We stratifi ed outcomes among 120 consecutive adult autologous
recipients (47 AML in fi rst remission, 24 HD, 27 MM, 16
NHL, 4ALL). HCT-CI risk was low in 10 (12%), intermediate in 22
(27%) high in 45 (55%) and undetermined in 5 (6%). Two year
OS was 45% (95%CI: 24–64%), 55% (95%CI: 40–68%) and 42%
(95%CI: 24–64%) in the low, intermediate and high-risk HCT-CI
groups respectively. Two year NRM was 36% (95% CI: 17–36%),
26% (95% CI: 15–39%) and 30% (95% CI: 22–39%) in the low,
intermediate and high-risk HCT-CI groups respectively. The multivariate
analysis revealed that HCT-CI failed in prediction of OS
and NRM but KPS (< 90%) was a strong predictor of NRM as
an independent predictor. The variables concerning mobilization
of stem cells (chemotherapy with G-CSF versus G-CSF alone
and the dose of infused CD34 + > 4,0 × 106/kg and < 4.0 × 106/kg
in the three risk HCT-CI groups revealed that patients with HCTCI
score > 3 and intermediate and high risk disease that received
< 4.0 × 106/kg had 2 year NRM <30% and OS<45%, as well the
patients mobilized with chemotherapy + G-CSF showed lower
NRM in the HCT-CI > 3 (intermediate and high risk disease). To
determine the validity of HCT-CI, KPS and weather to include the
the independent variables concerning the mobilization strategy
and stem cell dose that we analyzed, a multi-center collaboration
is necessary to produce an adequately powered validation study
for risk stratifi cation of autologous recipients.
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