Hematopoietic Cell Transplantation–Specific Comorbidity Index Predicts Morbidity and Mortality in Autologous Stem Cell Transplantation

Abstract

The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) score is a useful tool to assess the risk for nonrelapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation. Although the HCT-CI has been investigated in autologous stem cell transplantation (ASCT), its use is limited. To improve on the current use of the HCT-CI score on the morbidity and mortality after ASCT, we assessed the 100-day morbidity defined as orotracheal intubation (OTI), dialysis or shock (vasopressors need), 100-day NRM, early composite morbidity-mortality (combined endpoint that included any previous endpoints), and long-term NRM. We retrospectively reviewed a cohort of 1730 records of adult patients who received an ASCT in Argentinean center's between October 2002 and August 2016. Median follow-up was 1.15 years, and median age was 53 years. Diseases were multiple myeloma (48%), non-Hodgkin lymphoma (27%), and Hodgkin lymphoma (17%); 51% were in complete or partial remission; and 13% received ≥ 3 chemotherapy lines before transplant (heavily pretreated). Early NRM (100-day) was 2.7%, 5.4% required OTI, 4.5% required vasopressors, and 2.1% dialysis, with an early composite morbidity-mortality of 6.8%. Long-term (1 and 3 years) NRM was 4% and 5.2% and overall survival 89% and 77%, respectively. High-risk HCT-CI patients had a significant increase in 100-day NRM compared with intermediate and low risk (6.1% versus 3.4% versus 1.8%, respectively; P = .002), OTI (11% versus 6% versus 4%, P = .001), shock (8.7% versus 5.8% versus 3%, P = .001), early composite morbidity-mortality (13% versus 9 % versus 4.7%, P < .001), and long-term NRM (1 year, 7.7% versus 4% versus 3.3%; and 3 years, 10.8% versus 4% versus 4.8%, respectively; P = .002). After multivariate analysis these outcomes remained significant: early composite morbidity-mortality (odds ratio [95% confidence interval] compared with low risk: intermediate risk 2.1 [1.3 to 3.5] and high risk 3.3 [1.9 to 5.9]) and NRM (hazard ratio [95% confidence interval] compared with low risk: intermediate risk .97 [.8 to 2.4] and high risk 3.05 [1.3 to 4.5]). No significant impact was observed in overall survival. Other than comorbidities, significant impact was observed for heavily pretreated patients, age ≥ 55 years, non-Hodgkin lymphoma, and bendamustine-etoposide-citarabine-melphalan conditioning. We confirmed that the HCT-CI had a significant impact on NRM after ASCT, and these findings are mainly due to early toxicity express as 100-day NRM and the 3 main morbidity outcomes as well as the composite endpoint.

High‐dose Bendamustine‐EAM followed by autologous stem cell rescue results in long‐term remission rates in lymphoma patients, without renal toxicity

“…18 Additionally, some other study groups reported similar results, and one group even identified the BeEAM regimen being an independent risk factor for non-relapse mortality. [19][20][21] We observed in our 41 patients only a transient and not clinical relevant elevation in creatinine levels in the days following bendamustine. No therapeutic intervention was necessary due to renal toxicity.…”

“…Interestingly, in a retrospective analysis, they observed an increased renal toxicity in 28% of patients, including 4 patients with grades 3 and 4 side effects and one case of dialysis . Additionally, some other study groups reported similar results, and one group even identified the BeEAM regimen being an independent risk factor for non‐relapse mortality …”

Revised International Staging System Is Predictive and Prognostic for Early Relapse (<24 months) after Autologous Transplantation for Newly Diagnosed Multiple Myeloma

“…In addition to R-ISS, HCT-CI > 2, receipt of >1 line of pre-AHCT chemotherapy, and year of AHCT 2008 to 2011 (compared with 2012 to 2014) were associated with worse OS in this cohort. HCT-CI and lines of treatment have been shown to be associated with OS in MM in multiple studies [18][19][20]. Similarly, receipt of more than 1 line of therapy before AHCT has not shown to be of benefit even among patients who achieve suboptimal response to first line of treatment [21].…”

Impact of comorbidities constituting the hematopoietic cell transplant (HCT)‐comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia

“…The HCT‐CI is a tool designed to predict post‐HCT outcomes based on the collective influence of a number of pretransplant comorbidities. The comorbidity index is widely used for the assessment of the risk of NRM in both allogeneic and more recently autologous HCT . The purpose of the present retrospective study was to investigate the influence of the individual pretransplant parameters of the HCT‐CI on the outcomes of AML patients that underwent allogeneic HCT.…”

“…The comorbidity index is widely used for the assessment of the risk of NRM in both allogeneic and more recently autologous HCT. 20,21 The purpose of the present retrospective study was to investigate the influence of the individual pretransplant parameters of the HCT-CI on the outcomes of AML patients that underwent allogeneic HCT. The HCT-CI overall demonstrated prognostic stratification for OS in our cohort; however, a significant difference was not observed between the lower scores (0 vs 1-2).…”