Augmented Hematopoietic Cell Transplantation-Specific Comorbidity/Age Index May Have Prognostic Value

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There are currently limited data on recipients of allogeneic hematopoietic cell transplantation from alternative graft sources.
There are currently limited data on recipients of allogeneic hematopoietic cell transplantation from alternative graft sources.

The Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) is a tool used to predict HCT outcomes in recipients of alternative donor grafts. In a report published in Biology of Blood and Marrow Transplantation, researchers described an augmented comorbidity/age index comprising the HCT-CI, age, and serum values of albumin, ferritin, and platelets that may have higher predictive power for HCT outcomes in these patients.

The researchers examined the discriminative capacity of the augmented comorbidity/age index among 724 recipients of allogeneic HCT from human leukocyte antigen (HLA)-mismatched (345 patients), haploidentical (117 patients), and umbilical cord blood (UCB; 262 patients) grafts. All the patients were treated between 2000 and 2013.

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The augmented comorbidity/age index was found to have a higher c-statistic estimate for prediction of 2-year nonrelapse mortality compared with the original HCT-CI (0.63 vs 0.59; P =.0001). Similar results were found for recipients of HLA-mismatched (0.62 vs 0.59), haploidentical (0.60 vs 0.54), and UCB grafts (0.65 vs 0.61).

Compared with the HCT-CT alone, the augmented comorbidity/age index had higher predictive value for 2-year overall survival (c-statistic 0.60 vs 0.57; P =.0001). Additionally, higher scores on the augmented comorbidity/age index were typically associated with lower overall survival, regardless of graft source.

Until now, studies have looked mainly at the HCT-CI in recipients of allogeneic HCT from HLA-matched grafts. However, the augmented comorbidity/age index offers a discriminative model to determine outcomes in recipients of HLA-mismatched and UCB grafts as well. The authors noted that they “could not find an advantage of one graft source [compared with the others] within groups of patients with either low or high risk per comorbidity/age burden.”

Reference

1. Elsawy M, Storer BE, Milano F et al. Prognostic performance of the augmented hematopoietic cell transplantation-specific comorbidity/age index in recipients of allogeneic hematopoietic stem cell transplantation from alternative graft sources [published online November 27, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.11.030

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