Association of pre-existing comorbidities with outcome of allogeneic hematopoietic cell transplantation. A retrospective analysis from the EBMT.
Journal
Bone marrow transplantation
ISSN: 1476-5365
Titre abrégé: Bone Marrow Transplant
Pays: England
ID NLM: 8702459
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
09
04
2021
accepted:
06
10
2021
revised:
14
09
2021
pubmed:
1
11
2021
medline:
20
4
2022
entrez:
31
10
2021
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 34718346
doi: 10.1038/s41409-021-01502-8
pii: 10.1038/s41409-021-01502-8
pmc: PMC8821004
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
183-190Informations de copyright
© 2021. The Author(s).
Références
Passweg JR, Baldomero H, Chabannon C, Basak GW, Corbacioglu S, Duarte R, et al. The EBMT activity survey on hematopoietic-cell transplantation and cellular therapy 2018: CAR-T’s come into focus. Bone Marrow Transplant. 2020. https://doi.org/10.1038/s41409-020-0826-4
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. https://doi.org/10.1016/0021-9681(87)90171-8
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106:2912–9. https://doi.org/10.1182/blood-2005-05-2004
doi: 10.1182/blood-2005-05-2004
pubmed: 15994282
pmcid: 1895304
Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG, et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. 2007;25:4246–54. https://doi.org/10.1200/JCO.2006.09.7865
doi: 10.1200/JCO.2006.09.7865
pubmed: 17724349
Penack O, Peczynski C, Mohty M, Yakoub-Agha I, Styczynski J, Montoto S, et al. How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT. Blood Adv. 2020;4:6283–90. https://doi.org/10.1182/bloodadvances.2020003418
doi: 10.1182/bloodadvances.2020003418
pubmed: 33351121
pmcid: 7756984
Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 Consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15:825–8.
pubmed: 7581076
Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE, et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med. 1980;69:204–17. https://doi.org/10.1016/0002-9343(80)90380-0
doi: 10.1016/0002-9343(80)90380-0
pubmed: 6996481
Fine JP, Gray RJ. A Proportional Hazards Model for the Subdistribution of a Competing Risk. J Am Stat Assoc. 1999;94:496–509.
doi: 10.1080/01621459.1999.10474144
Fein JA, Shimoni A, Labopin M, Shem-Tov N, Yerushalmi R, Magen H, et al. The impact of individual comorbidities on non-relapse mortality following allogeneic hematopoietic stem cell transplantation. Leukemia. 2018;32:1787–94. https://doi.org/10.1038/s41375-018-0185-y
doi: 10.1038/s41375-018-0185-y
pubmed: 29950692
Sorror ML, Logan BR, Zhu X, Rizzo JD, Cooke KR, McCarthy PL, et al. Prospective validation of the predictive power of the hematopoietic cell transplantation comorbidity index: a Center for International Blood and Marrow Transplant Research Study. Biol Blood Marrow Transplant. 2015;21:1479–87. https://doi.org/10.1016/j.bbmt.2015.04.004
doi: 10.1016/j.bbmt.2015.04.004
pubmed: 25862591
pmcid: 4512746
Penack O, Marchetti M, Ruutu T, Aljurf M, Bacigalupo A, Bonifazi F, et al. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2020;7:e157–e167. https://doi.org/10.1016/S2352-3026(19)30256-X
doi: 10.1016/S2352-3026(19)30256-X
pubmed: 32004485
Styczynski J, Tridello G, Koster L, Iacobelli S, van Biezen A, van der Werf S, et al. Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors. Bone Marrow Transplant. 2020;55:126–36. https://doi.org/10.1038/s41409-019-0624-z
doi: 10.1038/s41409-019-0624-z
pubmed: 31455899
Khalil MMI, Lipton JH, Atenafu EG, Gupta V, Kim DD, Kuruvilla J, et al. Impact of comorbidities constituting the hematopoietic cell transplant (HCT)-comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia. Eur J Haematol. 2018;100:198–205. https://doi.org/10.1111/ejh.13000
doi: 10.1111/ejh.13000
pubmed: 29168234
Shouval R, Fein JA, Shouval A, Danylesko I, Shem-Tov N, Zlotnik M, et al. External validation and comparison of multiple prognostic scores in allogeneic hematopoietic stem cell transplantation. Blood Adv. 2019;3:1881–90. https://doi.org/10.1182/bloodadvances.2019032268
doi: 10.1182/bloodadvances.2019032268
pubmed: 31221661
pmcid: 6595255
Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME, et al. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 2014;123:3664–71. https://doi.org/10.1182/blood-2014-01-552984
doi: 10.1182/blood-2014-01-552984
pubmed: 24744269
pmcid: 4047501
Au BK, Gooley TA, Armand P, Fang M, Madtes DK, Sorror ML, et al. Reevaluation of the pretransplant assessment of mortality score after allogeneic hematopoietic transplantation. Biol Blood Marrow Transplant. 2015;21:848–854. https://doi.org/10.1016/j.bbmt.2015.01.011
doi: 10.1016/j.bbmt.2015.01.011
pubmed: 25644959
pmcid: 4408250
Luft T, Benner A, Terzer T, Jodele S, Dandoy CE, Storb R, et al. EASIX and mortality after allogeneic stem cell transplantation. Bone Marrow Transplant. 2020;55:553–61. https://doi.org/10.1038/s41409-019-0703-1
doi: 10.1038/s41409-019-0703-1
pubmed: 31558788