Influence of comorbidities on outcome in 1102 patients with an allogeneic hematopoietic stem cell transplantation

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Marie Janscak1,2, Anne Stelmes1,2, Jana van den Berg1,2

  • 1Division of Hematology, University Hospital Basel, Basel, Switzerland.

Bone Marrow Transplantation
|August 13, 2024
PubMed

Insights

The Hematopoietic Comorbidity Risk Index (HCT-CI) shows significant differences in non-relapse mortality (NRM) for low-risk patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Cardiac disease is a key predictor of NRM and overall survival.

Area of Science:

  • Hematology
  • Transplant Immunology
  • Oncology

Background:

  • The Hematopoietic Comorbidity Risk Index (HCT-CI) is a standard tool for assessing pre-transplant comorbidities in allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  • Advances in HSCT techniques and supportive care necessitate re-evaluation of the HCT-CI's predictive accuracy over time.
  • Previous studies established HCT-CI's utility in predicting non-relapse mortality (NRM).

Purpose of the Study:

  • To re-evaluate the predictive value of the HCT-CI in a contemporary cohort of allo-HSCT patients.
  • To assess the impact of specific comorbidities, particularly cardiac disease, on transplant outcomes.
  • To identify factors influencing NRM and overall survival (OS) in patients undergoing allo-HSCT.

Main Methods:

  • Retrospective analysis of 1102 consecutive patients undergoing allo-HSCT between 2006 and 2021.
  • Patients were stratified into low (HCT-CI 0), intermediate (HCT-CI 1-2), and high-risk (HCT-CI ≥3) groups.
  • Multivariate analysis was used to assess the association of HCT-CI, organ subgroups, donor type, disease status, and prior HSCT with NRM and OS.

Main Results:

  • At 10 years, NRM was 21.0% (low), 26.0% (intermediate), and 25.8% (high-risk), with a significant difference between low and intermediate groups (p<0.001).
  • Overall survival at 10 years was 49.9% (low), 39.8% (intermediate), and 31.1% (high-risk) (p<0.001).
  • Cardiac disease was the strongest predictor of NRM (HR=1.73, p=0.02) and OS (HR=1.77, p<0.001). Unrelated/mismatched related donors, advanced disease, and prior HSCT also impacted NRM.

Conclusions:

  • The HCT-CI remains a valuable tool, particularly in distinguishing low-risk patients, but its predictive power for intermediate vs. high-risk groups may be diminishing.
  • Cardiac disease is a critical comorbidity impacting allo-HSCT outcomes, warranting closer attention.
  • Improvements in transplant procedures and supportive care may be mitigating the impact of certain comorbidities on NRM.

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