Impact of allogeneic stem cell transplantation comorbidity indexes after haplotransplant using post-transplant
Maxime Jullien1, Corentin Orvain2, Ana Berceanu3
1Hematology Department, Nantes University Hospital, Nantes, France.
Insights
Pre-transplant comorbidity scores do not predict outcomes in haploidentical allogeneic hematopoietic stem cell transplantation (Allo-HSCT) with post-transplant cyclophosphamide (PTCY). These findings suggest that comorbidities should not contraindicate this expanding Allo-HSCT procedure.
Area of Science:
- Hematology
- Transplantation Medicine
- Oncology
Background:
- Established comorbidity indices predict outcomes in HLA-matched allogeneic hematopoietic stem cell transplantation (Allo-HSCT).
- Their utility in haploidentical Allo-HSCT with post-transplant cyclophosphamide (PTCY) is understudied.
- Haploidentical Allo-HSCT with PTCY is a rapidly expanding procedure globally.
Purpose of the Study:
- To evaluate the predictive performance of three established comorbidity scoring systems in haploidentical Allo-HSCT with PTCY.
- To determine if pre-transplant comorbidities influence survival and non-relapse mortality in this specific transplant setting.
Main Methods:
- Retrospective analysis of 223 patients undergoing haploidentical Allo-HSCT with PTCY across four centers.
- Assessment of three comorbidity scores: Hematopoietic Cell Transplantation-Specific Comorbidity Index, Comorbidity/Age index, and Augmented Comorbidity/Age index.
- Univariate and multivariate analyses to identify factors associated with overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM).
Main Results:
- Three-year OS, DFS, and NRM were 48.1%, 46.3%, and 30.0%, respectively.
- None of the three comorbidity scores showed a significant impact on OS, DFS, or NRM in univariate analysis.
- Multivariate analysis identified donor age (≥40 years) as a significant predictor of lower OS, DFS, and higher NRM, while recipient age (≥55 years) and DRI were associated with lower OS.
Conclusions:
- Current pre-transplant comorbidity scoring systems do not reliably predict outcomes in haploidentical Allo-HSCT with PTCY.
- Pre-transplant comorbidities should not be considered a contraindication for haploidentical Allo-HSCT with PTCY.
- Donor age is a critical factor influencing outcomes in this transplant setting.
Background:
Three different scoring systems have been developed to assess pre-transplant comorbidity in allogeneic hematopoietic stem cell transplantation (Allo-HSCT): the Hematopoietic Cell Transplantation-Specific Comorbidity Index, the Comorbidity/Age index, and the Augmented Comorbidity/Age index. All were devised to predict overall survival (OS) and disease-free survival (DFS) survivals and non-relapse mortality (NRM) in patients receiving HLA-matched Allo-HSCT, but their performance has scarcely been studied in the haploidentical Allo-HSCT setting with post-transplant cyclophosphamide, a procedure in constant expansion worldwide.
Methods:
To address this issue, their impact on survivals and NRM was examined in a cohort of 223 patients treated with haploidentical Allo-HSCT in four different centers.
Results:
With a median follow-up of 35.6 months, 3-year OS, DFS, and NRM were 48.1% ± 4%, 46.3% ± 4%, and 30.0% ± 3%, respectively. No impact was found for any of the three comorbidity scores in univariate analysis. In multivariate analyses, the only three factors associated with lower OS were DRI (p < 0.001), an older age of recipients (≥55 years old, p = 0.02) and of donors (≥40 years old, p = 0.005). Older donor age was also associated with lower DFS and higher NRM.
Conclusion:
The comorbidity scores do not predict survivals nor NRM in haploidentical Allo-HSCT with PTCY, suggesting that pre-transplant comorbidities should not be a contra-indication to this procedure.
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