Age Adjusted Comorbidity Risk Index Does Not Predict Outcomes in an Autologous Hematopoietic Stem Cell Transplant Population

Abstract

The hematopoietic comorbidity risk index (HCT-CI) is a pre-transplant risk assessment tool used to prognosticate morbidity and mortality of patients undergoing allogeneic hematopoietic stem cell transplantation. Recently, the HCT-CI was updated to include an age component (HCT-CI-age). Although other studies have validated this tool in allogeneic stem cell transplant recipients, it has never been studied in an autologous transplant patient population. We retrospectively reviewed 181 patients who underwent their first autologous hematopoietic stem cell transplant. We aimed (1) to assess whether an HCT-CI score of 3 or greater is associated with greater mean transplant hospital days, greater total hospital days, or greater risk of intensive care unit (ICU) utilization and (2) whether age influences any of these responses independent of HCT-CI. There were 136 patients with an HCT-CI score of 3 or higher and 45 with a score less than 3. The length of initial transplant hospitalization in days was not statistically significant (15.6 v 16.4 days, P = 0.38). Utilizing spline modeling prediction curves, transplant hospital days were estimated to increase from a mean of 15.5 days for a patient with 4 comorbidities to a mean of 22.7 days for a patient with 8 comorbidities. Age made no significant impact on any of the outcomes. The HCT-CI, with or without age, in an autologous stem cell transplantation did not predict length of hospitalization or utilization of the ICU. Patients with higher-HCT-CI scores at baseline may incrementally utilize more resources, and this should be explored in a larger cohort population.

High-dose chemotherapy and autologous hematopoietic stem cell transplantation for progressive systemic sclerosis: a retrospective study of outcome and prognostic factors

“…The HCT-CI was originally developed in the setting of allogeneic stem cell transplantation. Its validity in relation to autologous stem cell transplantation is still debated and its predictive power for TRM especially in systemic sclerosis has not yet been clarified (Saad et al 2014 ; Sorror et al 2015 ; Berro et al 2017 ; van Bijnen et al 2020 ; Barth et al 2022 ). Here, we demonstrated that patients with a high CCI and especially high HCT-CI were at significantly increased risk for TRM (OR 11, OR 24, respectively (Charlson et al 1987 ; Sorror et al 2005 ; Sorror et al 2014 )).…”

DNA Methylation Changes in Autologous Hematopoietic Stem Cell Transplant Patients

“…HCTs are classified based on the source of the transplanted hematopoietic progenitor cells, and autologous HCT (from self) are more common in patients diagnosed with multiple myeloma and lymphoproliferative disorders (D’Souza et al, 2020). Pre-transplant risk assessment tools such as the HCT-comorbidity index (HCT-CI) are consistently used in transplant only from donors (allogeneic HCT) and were not designed to predict outcomes in the autologous HCT population (Barth et al, 2022). Therefore, it is essential to measure other potential risk factors (such as frailty, cognitive decline, and fatigue) and investigate molecular biomarkers for poor outcomes (such as increased mortality and worse overall survival; Arora et al, 2021; Langlois et al, 2012; Uslu & Canbolat, 2021; Williams et al, 2016).…”