The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation

Abstract

The hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been developed to identify patients at high risk of mortality after an allograft. Reduced-intensity/ non-myeloablative regimens have decreased the non-relapse mortality (NRM) in elderly and/or heavily pretreated patients. We performed a retrospective study to assess whether HCT-CI may predict clinical outcomes in a cohort of 203 patients with nonHodgkin's (NHL; n ¼ 108), Hodgkin's lymphomas (HL; n ¼ 26), and multiple myeloma (MM; n ¼ 69), who were transplanted from a human leucocyte antigen (HLA)-matched sibling (n ¼ 121) or an unrelated donor (n ¼ 82) after a reduced-intensity regimen (n ¼ 154) or a low-dose total body irradiation-based non-myeloblative regimen (n ¼ 49). Cumulative incidence of NRM was 5, 16 and 20% at 1 year and 6, 24 and 27% at 2 years, for patients with an HCT-CI of 0, 1-2 and X3, respectively. By multivariate analysis, HCT-CI significantly predicted NRM (hazard ratio (HR) ¼ 1.6, P ¼ 0.03), overall survival (OS; HR ¼ 1.62, Po0.001) and progression-free survival (PFS; HR ¼ 1.43, P ¼ 0.002). Moreover, the Karnofsky performance status was also significantly associated with OS and NRM (HR ¼ 1.62, Po0.001 and HR ¼ 2.12, P ¼ 0.04, respectively). Conditioning type did not affect outcome after stratifying patients by HCT-CI. In the light of our study, all future prospective trials of the Gruppo Italiano Trapianti di Midollo (GITMO) will include the HCT-CI to stratify patients.

Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT

“…Indeed, several studies already addressed this concern. The validity of HCT-CI has been confirmed recently in lymphoma and myeloma patients treated with ALLO-RIC, 11 but other studies did not reproduce these results. 18,19 The patient population was equally distributed across the three different subgroups witnessing that this population was not positively selected.…”

“…Furthermore, the validity of HCT-CI score has been verified in retrospective studies of only ALLO-RIC patients. [10][11][12] At least two other scoring systems (Pretransplantation Assessment of Mortality (PAM) score and European BMT (EBMT) score) have been published, both capturing patient and disease characteristics, donor type and age, identifying groups with different survival and/or TRM. 13,14 However, for one of them only patients with myeloid malignancies were included.…”

Pretransplantation [18‐F]fluorodeoxyglucose positron emission tomography scan predicts outcome in patients with recurrent Hodgkin lymphoma or aggressive non‐Hodgkin lymphoma undergoing reduced‐intensity conditioning followed by allogeneic stem cell transplantation

“…Previous reports demonstrated that hematopoietic cell transplantation-specific comorbidity index (HCT-CI) and performance status were correlated independently with outcome. 27,28 Recently, Robinson et al investigated a population of 285 patients with affected HL who underwent RIC alloSCT and observed that both performance status and disease status at transplantation important clinical parameters for outcome. 29 The kinetics of disease recurrence were quite different in PET-positive patients: In patients with HL, disease progression usually was observed within the first 2 years after alloSCT; whereas most patients with aggressive NHL developed disease recurrence within the first 12 months, and then the curve reached a plateau.…”

Concise Review: The Role of Hematopoietic Stem Cell Transplantation in the Treatment of Acute Myeloid Leukemia

“…While older age has been widely used to exclude patients from transplantation, assessment of comorbid conditions as measured by the hematopoietic cell transplantationspecific comorbidity index may help estimate risk of treatment-related mortality following HSCT [15][16][17]. In the presence of significant comorbidities, the danger of transplantation is far greater than postremission chemotherapy and may exclude patients from HSCT.…”