Risk score for outcome after allogeneic hematopoietic stem cell transplantation

Abstract

BACKGROUND: It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general. METHODS: Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor‐recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5‐77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005. RESULTS: Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%‐73%) for risk score 0 for the whole cohort (75%, 95% CI, 72%‐78% for the most recent time cohort) to 24% (95% CI, 21%‐27% for risk score 6 and 7; 25%, 95% CI, 22%‐29% most recent cohort). Transplant‐related mortality increased from 15% (95% CI, 14%‐17%) for risk score 0 (11%, 95% CI, 9%‐13%, most recent cohort) to 47% with risk score 6 and 7 (95% CI, 44%‐50%) for the whole cohort (45%, 95% CI, 42%‐48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques. CONCLUSIONS: Five well‐defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies. Cancer 2009. © 2009 American Cancer Society.

Mortalidade relacionada ao transplante e fatores associados em pacientes submetidos ao transplante de células tronco hematopoiéticas: estudo de coorte

“…Considerando que fatores de ordem individual (idade avançada, recorrência da doença de base, comorbidades) e inerentes ao procedimento (toxicidade relacionada ao regime de condicionamento, DECH, infecções, entre outros), de modo geral, influenciam na gravidade do paciente (36) , muitos especialistas têm adotado os índices como escore de risco pré-TCTH (EBMT) e SAPS como ferramentas para predizer a mortalidade no TCTH (4,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) . (37,39) .…”

“…Quanto maior a pontuação do escore de risco, maior o risco de MRT e, menor a sobrevida (4,37,39,41) .…”

“…Na atualidade, dada a semelhança entre pacientes de UTI e aqueles de TCTH, em termos de gravidade, muitos autores têm utilizado o SAPS e o EBMT nos estudos epidemiológicos (9,10,37,44,(48)(49)(50) a fim de caracterizar os pacientes em termos de gravidade da doença e avaliar a qualidade da assistência, os riscos e a MRT no TCTH (4,14,38,39,41,47,48,(51)(52)(53)(54)(55)(56)(57) .…”

“…No TCTH, a MRT em diferentes países varia de 2% a 85% (9,10,39,51,(54)(55)(56)(57)(58) . A probabilidade de sobrevida, de um a cinco anos, identificada por escore de risco pré-TCTH do EBMT, varia de 10,5% a 60% (4,9,39,41,51,58,59) .…”

“…A probabilidade de sobrevida, de um a cinco anos, identificada por escore de risco pré-TCTH do EBMT, varia de 10,5% a 60% (4,9,39,41,51,58,59) .…”