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Published on: January 8, 2020

Impact of comorbidity indexes on non-relapse mortality

A Xhaard1, R Porcher, J W Chien

  • 1AP-HP, Hôpital Saint-Louis, Service d'Hématologie-Greffe, Paris, France.

Leukemia
|August 8, 2008
PubMed

Insights

Comorbidity indexes like CCI, HCT-CI, and PAM have limited predictive power for survival after hematopoietic stem cell transplantation (HSCT). Age, donor type, and hepatic disease were key factors for non-relapse mortality in this study.

Area of Science:

  • Hematology
  • Transplantation Medicine
  • Biostatistics

Background:

  • Comorbidity indexes (CI) are used to predict outcomes after allogeneic hematopoietic stem cell transplantation (HSCT).
  • Established indexes include the Charlson's comorbidity index (CCI), hematopoietic cell transplantation CI (HCT-CI), and the pre-transplantation assessment of mortality (PAM) score.
  • The comparative predictive accuracy of these indexes for survival post-HSCT remains unclear.

Purpose of the Study:

  • To evaluate and compare the predictive performance of CCI, HCT-CI, and PAM for non-relapse mortality (NRM) and overall survival in patients undergoing allogeneic HSCT.
  • To develop modified versions of HCT-CI and PAM that do not rely on pulmonary function tests (PFTs) due to data limitations.

Main Methods:

  • Retrospective analysis of 286 patients who underwent allogeneic HSCT.
  • Calculation of CCI, and development and application of reduced HCT-CI and adjusted PAM scores, omitting PFT data.
  • Multivariate analysis to identify individual factors associated with NRM.

Main Results:

  • The discriminative properties of CCI, reduced HCT-CI, and adjusted PAM for survival were found to be low in the studied cohort.
  • Significant differences in patient and transplant characteristics were noted compared to other cohorts, including a higher proportion of pediatric patients, cord blood HSCT, and HSCT for Fanconi anemia.
  • Multivariate analysis identified patient age, donor type (matched unrelated or mismatched), and hepatic disease as significant predictors of NRM.

Conclusions:

  • Existing comorbidity indexes demonstrate limited predictive accuracy for survival outcomes in this specific allogeneic HSCT population.
  • Age, donor match, and hepatic disease are significant factors influencing non-relapse mortality.
  • Prospective validation in larger, independent cohorts is necessary before these CIs can be reliably used for patient counseling or clinical decision-making regarding HSCT.

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