Impact of Pretransplantation Renal Dysfunction on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Farhadfar, Nosha; Dias, Ajoy; Wang, Tao; Fretham, Caitrin; Chhabra, Saurabh; Murthy, Hemant S.; Broglie, Larisa; D’Souza, Anita; Gadalla, Shahinaz M.; Gale, Robert Peter; Hashmi, Shahrukh K.; Al-Homsi, A. Samer; Hematti, Peiman; Rizzieri, David A.; Chee, Lynette; Lazarus, Hillard M.; Bredeson, Christopher; Jaimes, Edgar A.; Beitinjaneh, Amer; Bashey, Asad; Prestidge, Tim; Krem, Maxwell M.; Marks, David I.; Benoit, Stefanie; Yared, Jean A.; Nishihori, Taiga; Olsson, Richard F.; Freytes, César O.; Stadtmauer, Edward A.; Savani, Bipin N.; Sorror, Mohamed L.; Ganguly, Siddhartha; Wingard, John R.; Pasquini, Marcelo C.

doi:10.1016/j.jtct.2021.02.030

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…Instead, estimated glomerular filtration rate (eGFR) is a more accurate measure of renal function and even moderate reductions in eGFR are associated with increased NRM following transplantation. 10,11 To address these issues, we have recently developed the Simplified Comorbidity Index (SCI). This clinical score captures a small number of 'high-yield' comorbidities (pulmonary, renal, hepatic and cardiac) in addition to older age.…”

Section: Introductionmentioning

confidence: 99%

The Simplified Comorbidity Index predicts non‐relapse mortality in reduced‐intensity conditioning allogeneic haematopoietic cell transplantation

Elias,

Brown,

Devlin

et al. 2023

Br J Haematol

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SummaryComorbidity assessment before allogeneic haematopoietic cell transplantation (allo‐HCT) is essential for estimating non‐relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of ‘high‐yield’ comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34‐selected allo‐HCT. Here, we evaluated the SCI in a single‐centre cohort of 327 patients receiving reduced‐intensity conditioning followed by unmanipulated allografts from HLA‐matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0–1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3‐year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all‐cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1‐, 2‐ and 3‐year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo‐HCT from HLA‐matched donors after reduced‐intensity conditioning.

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Section: Introductionmentioning

confidence: 99%

The Simplified Comorbidity Index predicts non‐relapse mortality in reduced‐intensity conditioning allogeneic haematopoietic cell transplantation

Elias,

Brown,

Devlin

et al. 2023

Br J Haematol

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“…Risk factors for chronic kidney disease post-HSCT include poor pre-HSCT kidney function, pre-transplant chemotherapeutic exposures with ifosfamide and cisplatin, older age, female gender, use of nephrotoxic medications including calcineurin inhibitors, cytomegalovirus treatment and antibiotics, fludarabine administration, a primary diagnosis of multiple myeloma, hypertension, exposure to high-dose radiation, and acute and chronic GVHD [ 34 , 51 , 72 , 90 , 123 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 ]. Studies are conflicting regarding whether chronic kidney disease is not [ 120 , 137 ] or is [ 138 , 139 ] associated with decreased survival. Chronic kidney disease occurred in 22% of patients who underwent non-myeloablative conditioning at 4 years post-HSCT [ 73 ].…”

Section: Resultsmentioning

confidence: 99%

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Fitzhugh

Volanakis

Idassi

et al. 2022

JCM

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The goal of curing children and adults with sickle cell disease (SCD) is to maximize benefits and minimize intermediate and long-term adverse outcomes so that individuals can live an average life span with a high quality of life. While greater than 2000 individuals with SCD have been treated with curative therapy, systematic studies have not been performed to evaluate the long-term health effects of hematopoietic stem cell transplant (HSCT) in this population. Individuals with SCD suffer progressive heart, lung, and kidney disease prior to curative therapy. In adults, these sequalae are associated with earlier death. In comparison, individuals who undergo HSCT for cancer are heavily pretreated with chemotherapy, resulting in potential acute and chronic heart, lung, and kidney disease. The long-term health effects on the heart, lung, and kidney for children and adults undergoing HSCT for cancer have been extensively investigated. These studies provide the best available data to extrapolate the possible late health effects after curative therapy for SCD. Future research is needed to evaluate whether HSCT abates, stabilizes, or exacerbates heart, lung, kidney, and other diseases in children and adults with SCD receiving myeloablative and non-myeloablative conditioning regimens for curative therapy.

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“…A recent retrospective study detailed the outcomes of 46 patients from 35 centers who were on hemodialysis at the time of alloHCT. The 1-year probability of overall survival was 20%, with a dismal 67% probability of NRM [3] .…”

Section: Discussionmentioning

confidence: 97%

“…Herein, we present the case of a young woman with MDS who developed end-stage renal disease (ESRD) during induction. Patients on dialysis are often excluded from alloHCT due to an unacceptable risk of non-relapse mortality (NRM)[ 3 , 4 ]. Our institution pioneered simultaneous living donor kidney and hematopoietic cell transplantation in patients with hematologic malignancies, including for human leukocyte antigen (HLA)-haploidentical pairs, however logistical challenges during the COVID-19 pandemic temporarily limited the implementation of this approach [5] .…”

Section: Introductionmentioning

confidence: 99%

Delayed kidney transplantation after HLA-haploidentical hematopoietic cell transplantation in a young woman with myelodysplastic syndrome with renal failure

Miller

Hall

Cohen‐Bucay

et al. 2022

Leukemia Research Reports

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Impact of Pretransplantation Renal Dysfunction on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Cited by 14 publications

References 31 publications

The Simplified Comorbidity Index predicts non‐relapse mortality in reduced‐intensity conditioning allogeneic haematopoietic cell transplantation

The Simplified Comorbidity Index predicts non‐relapse mortality in reduced‐intensity conditioning allogeneic haematopoietic cell transplantation

Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies

Delayed kidney transplantation after HLA-haploidentical hematopoietic cell transplantation in a young woman with myelodysplastic syndrome with renal failure

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