Hematopoietic cell transplantation‐comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation

Abstract

BACKGROUND Elderly and medically infirm cancer patients are increasingly offered allogeneic nonmyeloablative hematopoietic cell transplantation (HCT). A better understanding of the impact of health status on HCT outcomes is warranted. Herein, a recently developed HCT‐specific comorbidity index (HCT‐CI) was compared with a widely acceptable measure of health status, the Karnofsky performance status (KPS). METHODS The outcomes of 341 patients were evaluated, conditioned for either related or unrelated HCT by 2‐gray (Gy) total body irradiation given alone or combined with fludarabine at a dose of 90 mg/m2. Comorbidities were assessed retrospectively by the HCT‐CI. Performance status before and toxicities after HCT were graded prospectively using the KPS and National Cancer Institute Common Toxicity criteria, respectively. RESULTS Weak Spearman rank correlations were noted between HCT‐CI and KPS and between the 2 measures and age, number of prior chemotherapy regimens, and intervals between diagnosis and HCT (all r < 0.20). High‐risk diseases correlated significantly with higher mean HCT‐CI scores (P = .009) but not low KPS (P = .37). In multivariate models, the HCT‐CI had significantly greater independent predictive power for toxicities (P = .004), nonrelapse mortality (P = .0002), and overall mortality (P = .0002) compared with the KPS (P = .05, .13, and .05, respectively). Using consolidated HCT‐CI and KPS scores, patients were stratified into 4 risk groups with 2‐year survivals of 68%, 58%, 41%, and 32%, respectively. CONCLUSIONS HCT‐CI and KPS should be assessed simultaneously before HCT. The use of both tools combined likely refines risk‐stratification for HCT outcomes. Novel guidelines for assessment of performance status among HCT patients are warranted. Cancer 2008. © 2008 American Cancer Society.

Predictive value of risk assessment scores in patients with hematologic malignancies undergoing reduced‐intensity conditioning allogeneic stem cell transplantation

“…We found that a higher cut-off value of the PAM score (> 24 vs. 24) was better for predicting the prognosis than the original cut-off value (>23 vs 23). In the present study, NRM was relatively low compared with past reports [9][10][11][12][14][15][16]. NRM in the previous reports which could not show utility of HCT-CI was also relatively low [14][15][16].…”

“…The rates of patients with HCT-CI > 2 and > 3 were 52.6% and 24.4% in the present study, respectively. The rates of patients with HCT-CI > 2 and > 3 were 32-76% and 20-50% in previous reports about HCT-CI in patients with RIC regimen [9][10][11][12][14][15][16], respectively. Although the rate of patients with HCT-CI > 2 in the present study was comparable to patients in the previous reports, the rate of patients with HCT-CI > 3 was relatively low compared with previous reports.…”

“…On the other hand, PAM score is a global risk assessment score including variable factors of comorbidity, condition of transplantation, and disease risk. The usefulness of these risk assessment scores has been validated by some previous studies [3][4][5][6][7][8][9][10][11][12][13], but the scores failed to predict mortality in other reports [14][15][16].…”

“…Pre-transplant risk-assessment could allow older and debilitated patients to undergo allo-SCT with RIC regimen. Although some studies of risk assessment in patients receiving RIC allo-SCT have already been performed, the effectiveness of pre-transplant risk-assessment scores predicting the outcome in this patient population has not been established [9][10][11][12][14][15][16]. Barba et al reported that the cut-off values for classifying risk groups may differ among various setting [9].…”

Effects of physical exercise on survival after allogeneic stem cell transplantation

“…The EBMT risk score 5 is a well-known tool that predicts the risk of death after allo-HCT using a score based on age, disease stage, time interval from diagnosis to transplant, donor type and donor-recipient gender combination. Prognostic validity has also been demonstrated by the clinician-assessed Karnofsky Performance Score and by the co-morbidity score by Sorror et al 6,7 A recently published pilot study by Wood et al suggests that cardiopulmonary fitness, as defined by either peak oxygen uptake or the 6-minute walk distance Test (6-MWD), is a predictor of symptom severity, quality of life, and mortality in patients undergoing allo-HCT. 8 The risk of mortality post-procedure was substantially higher in patients whose pre-procedure VO 2peak was 16 ml/kg/min compared with those with a VO 2peak >16 ml/kg/min (hazard ratio of 6.7).…”