Comorbidity indices in hematopoietic stem cell transplantation: a new report card

Abstract

Summary:Comorbid conditions have not been studied systematically for impact upon patient outcome in the setting of hematopoietic stem cell transplantation (HSCT). Patients formerly excluded from myeloablative transplant due to comorbid illnesses now receive reduced-intensity conditioning regimens; hence, the incidence of comorbid conditions in HSCT recipients is expected to increase. Comorbid grading systems developed without regard for oncology patients have been applied in retrospective fashion to HSCT patients. Two commonly used scales (Charlson Comorbidity Index and the Adult Comorbidity Inventory-27) fail to include critical information: tumor and histologic type/stage, extent of prior treatment, donor stem cell source and cell type and preparative regimen. Further, data are reported in retrospective rather than prospective fashion. Despite limitations, however, such grading systems exhibit ease and utility for evaluation and may have predictive value for patient outcome. Modifying such approaches to include additional factors and appropriate weighting of components may enable an improved comparison of techniques and study results. These scoring systems may elucidate predictors of outcome and disease natural history and enhance statistical efficiency methods of HSCT. Refined scoring could be used effectively to assign patients to differing transplant conditioning regimens, that is, myeloablative vs reduced intensity. Prospective validation of such grading systems is encouraged. Bone Marrow Transplantation (2005) 36, 475-479.

Reduced-intensity conditioning for acute myeloid leukemia: is this strategy correct

“…Several groups are in the process of developing more accurate comorbidity scoring systems that may lend clarity to the dilemma of choosing the intensity of the conditioning regimen. 39 Finally, some patients and physicians are not accepting of the increased risk of the myeloablative approach and elect a reduced-intensity conditioning transplant. As noted above, nonmyeloablative transplants appear to be associated with a lower treatment-related mortality and possibly a delayed onset and 'less virulent' course of acute GVHD.…”

Transfer of the hematopoietic stem cell transplant patient to the intensive care unit: does it really matter?

“…Alternatively, many such patients with comorbid illnesses now can be offered reduced-intensity conditioning rather than myeloablative therapy. 50 Progress in ICU management parallels the improved outcome of SCT patients. Lung protective strategies have been implemented successfully for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).…”

A modified comorbidity index for hematopoietic cell transplantation

“…This has led to the evaluation of comorbidity indices as independent predictors of outcomes such as overall survival (OS) and non-relapse mortality (NRM). [1][2][3][4] Common scales used include the Charlson Comorbidity Index, 1 the Kaplan-Feinstein Scale 2 and the Adult Comorbidity Inventory-27. 3 More recently, the HCTspecific comorbidity index (HCT-CI) was proposed to better predict outcomes of HCT recipients based on their preexisting comorbidities.…”