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Updated: Aug 22, 2025
Bone Marrow Transplantation Platform to Investigate the Role of Dendritic Cells in Graft-versus-Host Disease
Published on: March 17, 2020
Combining the Disease Risk Index and Hematopoietic Cell Transplant Co-Morbidity Index provides a comprehensive
Christina Cho1,2, Patrick Hilden3, Scott T Avecilla4
1Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Insights
A combined prognostic model using the Disease Risk Index and Hematopoietic Cell Transplantation Comorbidity Index effectively predicts survival outcomes after CD34+ selected hematopoietic stem cell transplantation. This approach aids in selecting optimal candidates for transplantation.
Area of Science:
- Hematology
- Transplant Immunology
- Oncology
Background:
- T cell depletion via CD34+ cell selection in allogeneic hematopoietic stem cell transplantation (HCT) reduces graft-versus-host disease (GvHD) without increasing relapse risk.
- Identifying optimal candidates for CD34+ selected HCT is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate a prognostic model combining the Disease Risk Index (DRI) and Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI).
- To determine patient outcomes based on disease- and patient-specific factors in the context of CD34+ selected HCT.
Main Methods:
- Retrospective analysis of 506 adult recipients of first allogeneic HCT with CD34+ selected peripheral blood stem cells (PBSCs).
- Patients received grafts from 7/8- or 8/8-matched donors for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), or myelodysplastic syndromes (MDS).
- Kaplan-Meier and competing risks methods were used to estimate overall survival (OS), relapse-free survival (RFS), relapse, and non-relapse mortality (NRM).
Main Results:
- Stratification by composite DRI and HCT-CI revealed significant differences in OS and RFS.
- High DRI was associated with a greater risk of death and relapse or death compared to low/intermediate DRI.
- The combined model demonstrated predictive value for survival post-transplant.
Conclusions:
- A prognostic model integrating DRI and HCT-CI effectively predicts survival after CD34+ selected HCT.
- This combined model can enhance clinical decision-making and patient selection for HCT.
- Further application in retrospective analyses and prospective trials is recommended.
Abstract:
T cell depletion by CD34+ cell selection of hematopoietic stem cell allografts ex vivo reduces the incidence and severity of GvHD, without increased risk of relapse in patients with acute leukemia in remission or MDS. The optimal candidate for CD34+-selected HCT remains unknown, however.
Objective:
To determine outcomes based on both disease- and patient-specific factors, we evaluated a prognostic model combining the Disease Risk Index (DRI) and Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), an approach recently shown to predicted overall survival in a broad population of allograft recipients (1).
Methods:
This was a retrospective analysis of 506 adult recipients of first allogeneic HCT with CD34+ selected PBSCs from 7/8- or 8/8-matched donors for AML (n = 290), ALL (n = 72), or MDS (n = 144). The Kaplan-Meier method estimated OS and RFS. The cumulative incidence method for competing risks estimated relapse and non-relapse mortality (NRM). We evaluated the univariate association between variables of interest and OS and RFS using the log-rank test. Cox regression models assessed the adjusted effect of covariates on OS/RFS.
Results:
Stratification of patients based on a composite of DRI (low/intermediate vs. high/very high) and HCT-CI (0-2 vs. ≥ 3) revealed differences in OS and RFS between the 4 groups. Compared with reference groups of patients with low/intermediate DRI and low or high HCT-CI, those with high DRI had a greater risk of death (HR 2.30; 95% CI 1.39, 3.81) and relapse or death (HR 2.50; 95% CI 1.55, 4.05) than patients with any HCT-CI but low/intermediate DRI (HR death 1.80; 95% CI 1.34, 2.43; HR relapse/death 1.68; 95% CI 1.26, 2.24).
Conclusions And Clinical Implications:
A model combining DRI and HCT-CI predicted survival after CD34+ cell-selected HCT. Application of this combined model to other cohorts, both in retrospective analyses and prospective trials, will enhance clinical decision making and patient selection for different transplant approaches.
Data Availability Statement:
The data that support the findings of this study are available on request from the corresponding author, C Cho. In order to protect the privacy of research participants, the data are not publicly available.
