Combination of the Hematopoietic Cell Transplantation Comorbidity Index and the European Group for Blood and Marrow Transplantation Score Allows a Better Stratification of High-Risk Patients Undergoing Reduced-Toxicity Allogeneic Hematopoietic Cell Transplantation

被引:35
作者
Barba, Pere [1 ]
Martino, Rodrigo [2 ]
Antonio Perez-Simon, Jose [3 ]
Fernandez-Aviles, Francesc [4 ]
Castillo, Nerea [1 ]
Luis Pinana, Jose [2 ]
Lopez-Anglada, Lucia [3 ]
Rovira, Montserrat [4 ]
Bosch, Francesc [1 ]
Carreras, Enric [4 ]
Lopez Corral, Lucia [3 ]
Sierra, Jorge [2 ,5 ]
Valcarcel, David [1 ]
机构
[1] Univ Autonoma Barcelona, Dept Hematol, Hosp Univ Vall dHebron, E-08193 Barcelona, Spain
[2] Hosp Santa Creu & Sant Pau, Dept Hematol, Barcelona, Spain
[3] Univ Hosp, Dept Hematol, Salamanca, Spain
[4] Hosp Clin Barcelona, Dept Hematol, Barcelona, Spain
[5] Blood & Tissue Bank Catalonia, Barcelona, Spain
关键词
EBMT score; HCT-CI; Reduced-intensity conditioning stem cell transplantation; Allo-reduced-intensity conditioning; Comorbidity; ACUTE MYELOID-LEUKEMIA; DISEASE STATUS; HCT-CI; INTENSITY; OUTCOMES; IMPACT; MYELODYSPLASIA; MORTALITY;
D O I
10.1016/j.bbmt.2013.10.011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
This study was conducted to determine whether the integration of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score would improve individual capacity for stratification of high-risk HCT candidates. A total of 442 consecutive patients receiving an allogeneic Ha after reduced-toxicity conditioning was included. Final Ha-a and EBMT scores were calculated and validated. Then, patients were grouped into a 6-category new combination model according to the HCT-CI (0, 1 to 2, >= 3) and EBMT scores (0 to 3, 4 to 7), and the model's predictive capacity was also evaluated. Median HCT-CI and EBMT scores were 3 and 4, respectively. Increased HCT-CI was associated with higher 4-year nonrelapse mortality (NRM) and lower 4-year overall survival (OS), whereas a high EBMT score was associated with higher 4-year NRM. The Ha-a showed a trend for a better predictive capacity than the EBMT score (c-statistic .6 versus .54, P = .1). According to the new model, patients within HCT-CI of 0 and HCT-CI of 1 to 2 groups had similar risk of NRM independently of their EBMT score. Within the HCT-CI >= 3 group, patients with low EBMT score showed lower NRM (25% versus 40%, P = .04) and a trend to higher OS (52% versus 36%, P = .06) than patients with a high EBMT score. Moreover, patients with Ha-a >= 3 and EBMT score 0 to 3 had similar outcomes than those with HCT-CI of 1 to 2. In conclusion, the combination of HCT-CI and the EBMT score is feasible and might contribute to a better identification of high-risk patients, improving selection of best allogeneic HCT candidates. (C) 2014 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:66 / 72
页数:7
相关论文
共 25 条
[1]   A disease risk index for patients undergoing allogeneic stem cell transplantation [J].
Armand, Philippe ;
Gibson, Christopher J. ;
Cutler, Corey ;
Ho, Vincent T. ;
Koreth, John ;
Alyea, Edwin P. ;
Ritz, Jerome ;
Sorror, Mohamed L. ;
Lee, Stephanie J. ;
Deeg, H. Joachim ;
Storer, Barry E. ;
Appelbaum, Frederick R. ;
Antin, Joseph H. ;
Soiffer, Robert J. ;
Kim, Haesook T. .
BLOOD, 2012, 120 (04) :905-913
[2]   Defining the Intensity of Conditioning Regimens: Working Definitions [J].
Bacigalupo, Andrea ;
Ballen, Karen ;
Rizzo, Doug ;
Giralt, Sergio ;
Lazarus, Hillard ;
Ho, Vincent ;
Apperley, Jane ;
Slavin, Shimon ;
Pasquini, Marcelo ;
Sandmaier, Brenda M. ;
Barrett, John ;
Blaise, Didier ;
Lowski, Robert ;
Horowitz, Mary .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2009, 15 (12) :1628-1633
[3]   Comparison of Two Pretransplant Predictive Models and a Flexible HCT-CI Using Different Cut off Points to Determine Low-, Intermediate-, and High-Risk Groups: The Flexible HCT-CI Is the Best Predictor of NRM and OS in a Population of Patients Undergoing allo-RIC [J].
Barba, Pere ;
Luis Pinana, Jose ;
Martino, Rodrigo ;
Valcarcel, David ;
Amoros, Alex ;
Sureda, Anna ;
Briones, Javier ;
Delgado, Julio ;
Brunet, Salut ;
Sierra, Jorge .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2010, 16 (03) :413-420
[4]   The Hematopoietic Cell Transplantation-Specific Comorbidity Index Fails to Predict Outcomes in High-Risk AML Patients Undergoing Allogeneic Transplantation-Investigation of Potential Limitations of the Index [J].
Birninger, Nicole ;
Bornhaeuser, Martin ;
Schaich, Markus ;
Ehninger, Gerhard ;
Schetelig, Johannes .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2011, 17 (12) :1822-1832
[5]   Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT [J].
Castagna, L. ;
Fuerst, S. ;
Marchetti, N. ;
El Cheikh, J. ;
Faucher, C. ;
Mohty, M. ;
Bouabdallah, R. ;
Vey, N. ;
Stoppa, A. M. ;
Esterni, B. ;
Blaise, D. .
BONE MARROW TRANSPLANTATION, 2011, 46 (07) :1000-1005
[6]   The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation [J].
Farina, L. ;
Bruno, B. ;
Patriarca, F. ;
Spina, F. ;
Sorasio, R. ;
Morelli, M. ;
Fanin, R. ;
Boccadoro, M. ;
Corradini, P. .
LEUKEMIA, 2009, 23 (06) :1131-1138
[7]   The EBMT risk score [J].
Gratwohl, A. .
BONE MARROW TRANSPLANTATION, 2012, 47 (06) :749-756
[8]   Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation [J].
Gratwohl, A ;
Hermans, J ;
Goldman, JM ;
Arcese, W ;
Carreras, E ;
Devergie, A ;
Frassoni, F ;
Gahrton, G ;
Kolb, H ;
Niederwieser, D ;
Ruutu, T ;
Vernant, JP ;
de Witte, T ;
Apperley, J .
LANCET, 1998, 352 (9134) :1087-1092
[9]   REGRESSION MODELING STRATEGIES FOR IMPROVED PROGNOSTIC PREDICTION [J].
HARRELL, FE ;
LEE, KL ;
CALIFF, RM ;
PRYOR, DB ;
ROSATI, RA .
STATISTICS IN MEDICINE, 1984, 3 (02) :143-152
[10]   Suggestions on the use of statistical methodologies in studies of the European Group for Blood and Marrow Transplantation [J].
Iacobelli, Simona .
BONE MARROW TRANSPLANTATION, 2013, 48 :S1-S37