Comorbidities and Hematopoietic Cell Transplantation Outcomes

Abstract

Conventional allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for various hematological diseases due, in part to high-dose conditioning and, in part, to graft-versus-tumor effects. Reduced-intensity or non-myeloablative conditioning regimens have relied mostly on graft-versus-tumor effects for disease control, and their advent has allowed relatively older and medically infirm patients to be offered allo-HCT. However, both HCT modalities have been associated with organ toxicities and graft-versus-host disease, resulting in substantial non-relapse mortality. It has become increasingly important to optimize pre-transplant risk assessment in order to improve HCT decision making and clinical trial assignments. Single-organ comorbidity involving liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. Recent efforts have resulted in the advent of a weighted scoring system that could sensitively capture multiple-organ comorbidities prior to HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality than other non-HCT-specific indices. Subsequent studies, with the exception of a few studies with modest numbers of patients, have confirmed the prognostic importance of the HCT-CI. Further, the HCT-CI has been consolidated with various disease-specific and patient-specific risk factors to refine assignments of patients to the appropriate HCT setting. Ongoing studies are addressing prospective validation of the HCT-CI, furthering our understanding of biological aging, and enhancing the applicability of the HCT-CI comorbidity coding. Future knowledge of the impacts of multiple comorbidities on post-HCT toxicities might guide new prophylactic and therapeutic interventions to lessen the procedure's mortality.

Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients

“…Appropriate patient selection is important to limit the risk of adverse outcomes and identification of patients at high risk for complications is possible using screening questionnaires and tools such as the HCT-CI score. 23,25,26 Our study shows that pre-transplant QOL, especially domains that assess the physical and FWB of a patient, may add to the prognostic information that is provided by other risk factors for survival.…”

Age-adjusted recipient pretransplantation telomere length and treatment-related mortality after hematopoietic stem cell transplantation

“…Standard factors, such as age, type, and stage of the underlying disease, as well as pretransplantation comorbidities are not sufficient to precisely predict transplantation tolerance and posttransplantation survival. 2 Some biomarkers, such as elevated pretransplantation serum ferritin and C-reactive protein (CRP) levels, have been suggested to be associated with an increased risk of morbidity and mortality after HSCT. [3][4][5] Telomeres are highly conserved protective terminal chromosomal structures consisting of hundreds to thousands of tandem TTAGGG hexamers and their associated shelterin proteins.…”

How to manage high-risk acute myeloid leukemia

“…The role of co-morbidities in predicting TRM remains incompletely explored. Sorror 6,7 has reported the profound role played by such co-morbidities in determining TRM after allogeneic hematopoietic cell transplantation (HCT).…”