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Cardiopulmonary Exercise Test With Comorbidity Index Before Allogeneic Hematopoietic Stem Cell Transplantation
Sang Hoon Yeon1, Myung-Won Lee1, Thi Thuy Duong2,3
1Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
Insights
A new composite score combining cardiopulmonary exercise test (CPET) and comorbidity index effectively predicts survival and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). This tool aids in risk stratification for hematological malignancy patients.
Area of Science:
- Hematology
- Oncology
- Cardiology
- Transplantation Medicine
Background:
- Allogeneic hematopoietic stem cell transplantation (HSCT) is a critical treatment for hematological malignancies.
- Accurate prediction of overall survival (OS) and non-relapse mortality (NRM) is essential for patient management.
- The cardiopulmonary exercise test (CPET) assesses cardiorespiratory fitness, a potential prognostic factor.
Purpose of the Study:
- To evaluate the predictive role of CPET, combined with a comorbidity index, for OS and NRM in patients undergoing allogeneic HSCT.
- To develop and validate a composite index integrating CPET and comorbidity data.
Main Methods:
- Retrospective analysis of 72 adult patients with hematological malignancies undergoing HLA-matched donor-HSCT.
- Maximal oxygen consumption (VO2max) was assessed and categorized.
- A composite Hematopoietic Cell Transplantation-specific Comorbidity Index/CPET (HCT-CI/CPET) score was created.
Main Results:
- Lower VO2max (<25th percentile) did not significantly impact OS or NRM individually.
- Patients with a composite HCT-CI/CPET score ≥2 had significantly worse OS and higher NRM compared to those with scores 0-1.
- An HCT-CI/CPET score ≥2 was identified as the sole adverse risk factor for NRM on multivariate analysis.
Conclusions:
- The composite HCT-CI/CPET score is a valuable tool for predicting survival and mortality in patients undergoing allogeneic HSCT for hematological malignancies.
- This integrated approach enhances risk stratification beyond traditional comorbidity indices alone.
Purpose:
To evaluate the role of the cardiopulmonary exercise test (CPET) with comorbidity index as a predictor of overall survival (OS) and non-relapse mortality (NRM) in patients with hematological malignancies who undergo allogeneic hematopoietic stem cell transplantation (HSCT).
Methods:
We retrospectively analyzed consecutive adult patients with hematological malignancies who underwent HLA-matched donor-HSCT at Chungnam National University Hospital (Daejeon, South Korea) between January 2014 and December 2020. Maximal oxygen consumption (VO2max) was classified using the recommendations of the Mayo Clinic database.
Results:
Of 72 patients, 38 (52.8%) had VO2max values lower than the 25th percentile (VO2max ≤ 25th) of an age- and sex-matched normal population. Patients with VO2max ≤ 25th had no significant differences both OS and NRM (30 month OS 29.8% vs 41%, P = .328; and 30 month NRM 16% vs 3.3%, P = .222), compared with other patients. VO2max ≤ 25th was assigned a weight of 1 when added to the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to form a composite comorbidity/CPET index (HCT-CI/CPET). Patients with HCT-CI/CPET scores of 0 to 1 demonstrated significantly better OS and NRM than did patients with HCT-CI/CPET scores ≥2 [median OS not reached vs 6 months, P < .001 and 30 month NRM 7.4% vs 33.3%, P = .006]. An HCT-CI/CPET score ≥2 was the only adverse risk factor for NRM on multivariate analysis [hazard ratio (HR) of NRM 10.36 (95% CI 1.486-2.25, P = .018)].
Conclusion:
The composite HCT-CI/CPET score can predict the survival and mortality of patients with hematological malignancies who undergo allogeneic HSCT.
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