Pre‐transplant comorbidity burden and post‐transplant chronic graft‐versus‐host disease

Abstract

Summary The Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) was designed as a predictor of non-relapse mortality after HCT. Chronic graft-versus-host disease (GVHD) contributes to mortality after HCT. Here, we investigated whether the HCT-CI could predict development of chronic GVHD or post-chronic GVHD mortality. We retrospectively analyzed data from 2,909 patients treated at four institutions with allogeneic HCT for malignant and non-malignant hematologic conditions. In Cox regression models adjusted for potential confounders, increasing HCT-CI was not statistically significantly associated with the development of chronic GVHD (hazard ratio [HR]: 1.02, P = 0.34). Yet, the index was associated with an increased risk of non-relapse mortality (HR 1.29, P <0.0001) as well as overall mortality (HR: 1.25, P < .001) following the development of chronic GVHD. The association between HCT-CI and post-chronic GVHD mortality was similar regardless of donor type or stem cell source. HCT-CI scores could be incorporated in the design of clinical trials for treatment of chronic GVHD.

Utilization of Palliative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During Hospitalization: A Population-Based National Study

“…Graft-versus-host disease was a common posttransplantation complication that could lead to significant morbidity and mortality after allogeneic HSCT. 33,34 It has been previously observed that GVHD could impair QOL in survivors of HSCT 35 and our study indicated that GVHD was related to more frequent PC use. Among decedents who underwent allogeneic HSCT, Hispanic populations were less likely to receive PC than Caucasian populations.…”

Superior immune reconstitution using Treg-expanded donor cells versus PTCy treatment in preclinical HSCT models

“…Comorbidities present in HSCT recipients at the time of transplant are associated with decreased overall survival due to increased rates of nonrelapse mortality (NRM), including adverse outcomes associated with acute and chronic GVHD (42)(43)(44). Thus, GVHD prophylaxis strategies that minimize additional systemic toxicities in the early posttransplant period should provide clinical benefits by lowering NRM risks after aHSCT.…”

Pretransplant β 2 -Microglobulin Is Associated with the Risk of Acute Graft-versus-Host-Disease after Allogeneic Hematopoietic Cell Transplant

“…A more recent report demonstrated that the incorporation of classic inflammatory biomarkers such as ferritin and albumin to the HCT-CI increased the performance of this index in predicting outcomes after allo-HCT [5]. Interestingly, the HCT-CI was not associated with the development of chronic GVHD [6], suggesting that the mechanisms by which comorbidities influence outcomes after allo-HCT are at least partially related to the pathophysiologic mechanisms of aGVHD.…”