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