Comorbidities, Alcohol Use Disorder, and Age Predict Outcomes after Autologous Hematopoietic Cell Transplantation for Lymphoma

Graf, Solomon A.; Vaughn, Jennifer; Chauncey, Thomas R.; Storer, Barry E.; Gopal, Ajay K.; Holmberg, Leona; Bensinger, William I.; Maloney, David G.; Press, Oliver W.; Storb, Rainer; Sorror, Mohamed L.

doi:10.1016/j.bbmt.2016.06.007

Cited by 21 publications

(13 citation statements)

References 34 publications

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“…2 Comorbidities and age were reported to impact the prognosis of patients with lymphoma undergoing auto-HSCT. 3,4 However, the assessment of organ dysfunction prior to auto-HSCT has not been well studied in an effort to predict complications and outcome after auto-HSCT.…”

Section: Introductionmentioning

confidence: 99%

The impact of pulmonary function in patients undergoing autologous stem cell transplantation

Duque‐Afonso¹,

Ewald²,

Ihorst³

et al. 2021

Blood Advances

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High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (auto-HSCT) is an established therapy for patients with hematological malignancies. The age of patients undergoing auto-HSCT, and therefore the co-morbidities, has increased during the last decades. However, the assessment of organ dysfunction prior auto-HSCT has not been well undertaken. Therefore, we analyzed retrospectively the association of clinical factors, lung and cardiac function with outcome and complications after conditioning with BEAM (BCNU/carmustin, etoposide, cytarabine, melphalan) and high-dose melphalan of patients undergoing auto-HSCT. In this study, we included 629 patients treated with auto-HSCT (334 conditioned with BEAM and 295 with high-dose melphalan) at our institution between 2007 and 2017. The median follow-up for patients conditioned with BEAM was 52 months (range:0.2-152) and with high-dose melphalan 50 months (range:0.5-149). In the multivariate analysis, we identified progressive disease, CO-diffusion capacity corrected for hemoglobin (DLCOcSB)<60% of predicted, Karnofsky performance status (KPS)≤80%, HCT-CI score≥4 and age>70 years to be associated with decreased overall survival (OS) in patients treated with BEAM. Similarly, DLCOcSB<60% of predicted, HCT-CI score ≥4 and age>60 years were identified in patients treated with high-dose melphalan. Abnormalities in DLCOcSB<60% of predicted were associated with chemotherapy with lung toxic substances, mediastinal radiotherapy, KPS≤80%, current/previous smoking and treatment at the intensive care unit. Patients with decreased DLCOcSB<60% of predicted had more frequently non-relapse mortality, including pulmonary cause of death. In summary, we have identified DLCOcSB<60% of predicted as an independent risk factor associated with decreased OS in patients conditioned with BEAM and high-dose melphalan prior auto-HSCT.

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Section: Introductionmentioning

confidence: 99%

The impact of pulmonary function in patients undergoing autologous stem cell transplantation

Duque‐Afonso¹,

Ewald²,

Ihorst³

et al. 2021

Blood Advances

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“…Wildes et al found that a higher CCI score was negatively associated with survival after ASCT among 159 patients with NHL 23. Graf et al showed that higher hematopoietic cell transplantation-specific comorbidity index scores predicted non-relapse mortality after ASCT among 754 lymphoma patients (HR 1.94, 95% CI: 1.0–3.7) 24. Primary refractory disease has also been shown to be associated with impaired survival after ASCT; in the CORAL study, 3-year OS was 39% and 64% for patients with refractory and relapsed disease, respectively 8.…”

Section: Discussionmentioning

confidence: 99%

<p>Treatment intensity and survival in patients with relapsed or refractory diffuse large B-cell lymphoma in Denmark: a real-life population-based study</p>

Arboe

Olsen

Gørløv

et al. 2019

CLEP

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Purpose High-dose chemotherapy with autologous stem cell transplantation (ASCT) is considered to be the only curative treatment option for patients with refractory or relapsed diffuse large B-cell lymphoma (DLBCL). Due to toxicity, not all patients are eligible for this treatment leading to different treatment intensities. Here, we aim to analyze the impact of treatment intensity on survival in patients previously treated with rituximab and chemotherapy, and, furthermore, to analyze the association between socioeconomic position and treatment intensity, defined as palliation, non-salvage, and salvage regimens. Materials and methods We identified patients with refractory or relapsed DLBCL diagnosed in 2000–2015 in the Danish National Lymphoma Registry (n=1,228). We analyzed the impact of treatment intensity on survival in patients previously treated with rituximab (n=277) using a Cox proportional hazards model. Multinomial regression analyses were performed to identify associations between socioeconomic factors and treatment intensity for the entire cohort. Results In the rituximab era, the 5-year overall survival (OS) was 31% for patients receiving salvage regimens (n=194), and 17% for patients receiving non-salvage regimens (n=83). In the adjusted analysis, HR was 1.88, 95% CI: 0.9–3.9 for patients receiving salvage regimens. Patients living alone were significantly less likely to receive salvage regimens, as were patients with two or more comorbidities. Conclusion We observed a better OS in patients treated with salvage regimens compared with non-salvage regimens; however, the adjusted analysis contradicts this. Furthermore, our results indicate that there is a chance of remission for patients not eligible for ASCT.

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“…Alcohol intake, hypertriglyceridemia, and DKA are well-established risk factors for the development of AP and may explain their higher incidence. Alcohol use disorder has been found to be an independent risk factor for mortality in HSCT patients [ 18 ]. Despite adjusting for alcohol use disorder, our study revealed higher mortality in the AP group.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients

et al. 2022

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Background: Acute pancreatitis (AP) carries a significant morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT. Methods:We queried the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with a length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost, and charges was assessed using univariate analysis followed by multivariate analysis.Results: Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed AP. There was 1.74 times higher risk of mortality in patients with AP as compared to controls (adjusted odds ratio (aOR): 1.74, P = 0.0055). There was no statistically significant difference in the length of stay, hospitalization charge, or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 3.85 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 3.85, P = 0.003). There was a statistically significant increase noted in the length of stay (adj coeff: 20.3 days, P = 0.002), hospital charges (+$346,616, P = 0.017), and cost (+$121,932.4, P = 0.001) in patients with AP as compared to those who did not develop AP. Conclusion:Recipients of HSCT who develop AP have shown to have higher mortality on sensitivity analysis. This study highlights that AP in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware of this association as the presence of pancreatitis portends a poor prognosis.

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Comorbidities, Alcohol Use Disorder, and Age Predict Outcomes after Autologous Hematopoietic Cell Transplantation for Lymphoma

Cited by 21 publications

References 34 publications

The impact of pulmonary function in patients undergoing autologous stem cell transplantation

The impact of pulmonary function in patients undergoing autologous stem cell transplantation

<p>Treatment intensity and survival in patients with relapsed or refractory diffuse large B-cell lymphoma in Denmark: a real-life population-based study</p>

Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients

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