A Modified Hematopoietic Cell Transplantation (HCT)-Specific-Comorbidity Index.

Abstract

Charlson Comorbidity Index (CCI) is a weighted index that assigns scores to comorbidities and has been applied to predict mortality for patients (pts) with various medical conditions including solid tumors. Recently, CCI was used to predict the risk of non-relapse mortality (NRM) and overall survival (OS) for pts with hematologic malignancies given ablative or nonablative HCT1. The aim of this study is to a) better define previously identified comorbidities, b) investigate additional HCT-related comorbidities, and c) establish comorbidity scores suitable for HCT. We retrospectively reviewed comorbidities and laboratory data of 1058 pts given HCT at our center between 1997–2003 after ablative (n=763) or nonablative (n=295) conditioning (Table 1). The following refinements of the original CCI were made: pulmonary functions tests (PFTs) were used for pulmonary, liver function tests for hepatic, and ejection fraction ≤50% added to cardiac comorbidities. Also, new comorbidities were evaluated including bleeding, recent infections under treatment, depression, and obesity. Pts were randomly divided into a training (n=710) and a testing set (n=349). In the training set, the unadjusted HRs for 2-year NRM were calculated for each comorbidity. These values were then adjusted for other comorbidities, disease risk, conditioning type, and pt age. The adjusted HRs were employed as weights for individual comorbidities (Table 2). The refined pulmonary and hepatic comorbidity definitions were useful in identifying pts with increased risk of NRM. In addition, new comorbidities such as infection, bleeding, depression, and obesity appeared to be predictive. Some comorbidities had higher scores than the original CCI due to higher predictive power in the training set. The modified score was then validated in the testing set. The 2-year rates of NRM for scores of 0, 1–2, and ≥3 were 13%, 24%, and 40%, respectively, and of OS were 71%, 56%, and 37%, respectively. Applying the scores to nonablative and ablative pts, respectively, NRM of 9 vs 12% (p=0.04) were seen for score 0, 17 vs 27% (p=0.002) for scores 1–2, and 39 vs 42% (p=0.18) for scores ≥3. This modified HCT-specific comorbidity index provided a simple, readily applicable and valid method of estimating the risk of NRM and OS among pts given ablative or nonablative HCT. We suggest using this index in assessing risks for NRM and OS before allogeneic HCT.Sorror M et al. Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplant comorbidities. Blood. Online April 27, 2004; DOI 10.1182/blood-2004-02-0545Table 1: ptsNonablative(n=295), %Ablative(n=763), %PConditioningTBI230TBI/FLU770BU/CY060CY/TBI040Age, median (range) years54 (1–73)42 (1–66)<0.0001Prior HCT402<0.0001High disease risk7852<0.0001Marrow grafts538<0.0001Unrelated donor43412-year NRM24242-year OS5661TBI-total body irradiation, FLU-fludarabine, BU-busulfan, and CY-cyclophosphamideTable 2: Modified weighted indexComorbiditiesAssigned weightsHypertension0Arrythmia0Gastrointestinal0Mild PFTs reductions0Mild renal0Endocrine0Cardiac1Asthma1Mild hepatic1Diabetes1Cerebrovascular1Infection1Obesity1Bleeding1Moderate PFTs reductions2Peptic ulcer2Depression2Valvular3Moderate-severe renal3Moderate-severe hepatic3Prior solid tumor3Severe PFTs reductions4