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The Simplified Comorbidity Index: a new tool for prediction of nonrelapse mortality in allo-HCT

Roni Shouval1,2,3, Joshua A Fein4, Christina Cho1,3

  • 1Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Blood Advances
|September 10, 2021
PubMed

Insights

A new Simplified Comorbidity Index (SCI) effectively predicts nonrelapse mortality (NRM) after allogeneic hematopoietic cell transplantation (allo-HCT). This index stratifies patients into distinct risk groups, outperforming the HCT-CI in validation studies.

Area of Science:

  • Hematology
  • Transplant Immunology
  • Oncology

Background:

  • Nonrelapse mortality (NRM) is a critical outcome following allogeneic hematopoietic cell transplantation (allo-HCT).
  • Individual comorbidities significantly influence NRM, but their combined impact requires further elucidation.

Purpose of the Study:

  • To investigate the individual and combined effects of comorbidities on NRM after allo-HCT.
  • To develop and validate a novel comorbidity index for predicting NRM in allo-HCT recipients.

Main Methods:

  • Analysis of a single-center cohort of 573 adult patients undergoing CD34-selected allo-HCT with myeloablative conditioning.
  • Multivariable Cox regression to identify predictors of NRM.
  • Development and validation of a Simplified Comorbidity Index (SCI) using identified predictors and an external cohort of 230 patients.

Main Results:

  • Pulmonary disease, moderate-to-severe hepatic comorbidity, cardiac disease, and renal dysfunction were independently associated with increased NRM.
  • The SCI, incorporating these comorbidities and age >60, stratified patients into 5 risk groups with NRM rates from 11.4% to 49.9%.
  • The SCI demonstrated superior predictive performance (AUC 70.3-72.0) compared to the HCT-CI (AUC 61.7-65.7) in both development and validation cohorts.

Conclusions:

  • A focused set of comorbidities, aggregated into the SCI, accurately predicts NRM after allo-HCT.
  • The SCI effectively stratifies patients into distinct risk categories and offers improved discrimination over the HCT-CI.
  • The SCI's validity in an external cohort supports its utility in clinical practice for risk assessment in allo-HCT patients.

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