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Updated: Jun 8, 2026
05:37
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Adjusting Disease Risk Index for Regional Variations and Donor Selection
Makoto Iwasaki1, Yachiyo Kuwatsuka2, Hiromi Hayashi1
1Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Transplantation and Cellular Therapy
|June 6, 2026
Summary
A new region-adjusted Disease Risk Index (raDRI) improves prognostic accuracy for hematopoietic stem cell transplantation (HSCT). The raDRI guides donor selection, showing matched related donors improve survival in low-risk patients.
Area of Science:
- Hematology
- Transplantation Medicine
- Biostatistics
Background:
- The Disease Risk Index (DRI) is a standard prognostic tool for hematopoietic stem cell transplantation (HSCT).
- The refined DRI (rDRI) has limitations in accounting for regional variations in disease prevalence and treatment strategies.
Purpose of the Study:
- To refine the rDRI by incorporating underrepresented disease entities and regional HSCT treatment differences.
- To develop a region-adjusted DRI (raDRI) and identify optimal donor selection strategies based on new risk criteria.
Main Methods:
- Analyzed 7,720 patients undergoing first allogeneic HSCT (2014-2016) using Japanese registry data to develop the raDRI.
- Validated the raDRI's predictive performance in a separate cohort of 5,108 patients transplanted (2017-2018).
Main Results:
- The raDRI demonstrated superior predictive accuracy over the rDRI (AUC: 0.705 vs. 0.670).
- In low-to-intermediate risk patients (raDRI), matched related donors (MRD) improved overall survival compared to matched unrelated donors.
- No significant survival differences were observed between MRD and matched unrelated donors in high-risk patients.
Conclusions:
- Prognostic indices like the DRI are influenced by the specific populations and clinical practices of their origin.
- Regional variations in disease prevalence, treatment, and donor selection significantly impact HSCT risk stratification and outcomes.
- The developed raDRI offers improved risk assessment and informs donor selection strategies in HSCT.
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