Abstract
Although the application of Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) has enabled better prediction of transplant-related mortality (TRM) in allogeneic hematopoietic stem cell transplants (AHSCT), data from developing countries are scarce. This study prospectively evaluated the HCT-CI and the Adult Comorbidity Evaluation (ACE-27), in its original and in a modified version, as predictors of post-transplant complications in adults undergoing a first related or unrelated AHSCT in Brazil. Both bone marrow (BM) and peripheral blood stem cells (PBSC) as graft sources were included. We analyzed the cumulative incidence of granulocyte and platelet recovery, sinusoidal obstructive syndrome, acute and chronic graft-versus-host disease, relapse and transplant-related mortality, and rates of event-free survival and overall survival. Ninety-nine patients were assessed. Median age was 38 years (18–65 years); HCT-CI ≥ 3 accounted for only 8% of cases; hematologic malignancies comprised 75.8% of the indications for AHSCT. There was no association between the HCT-CI or the original or modified ACE-27 with TRM or any other studied outcomes after AHSCT. These results show that, in the population studied, none of the comorbidity indexes seem to be associated with AHSCT outcomes. A significantly low frequency of high-risk (HCT-CI ≥ 3) in this Brazilian population might justify these results.
Highlights
Allogeneic hematopoietic stem cell transplantation (AHSCT) is a potentially curative treatment option for different hematological malignancies and non-malignant diseases [1]
In an attempt to improve the assessment of the comorbidity risk profile in AHSCT patients, the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-cumulative incidence (CI)) was developed [7,9] The HCT-CI included a larger number of pre-transplant comorbidities compared to Charlson’s Comorbidity Index (CCI) and provided a better predictability of transplant-related mortality (TRM) and overall survival (OS) [7,9]
Hematologic malignancies accounted for 75.8% of all cases (n = 75)
Summary
Allogeneic hematopoietic stem cell transplantation (AHSCT) is a potentially curative treatment option for different hematological malignancies and non-malignant diseases [1]. Three main factors influence mortality and survival rates after AHSCT: the primary disease per se, donor type, and patient-related factors, such as the presence of comorbidities [2]. In an attempt to improve the assessment of the comorbidity risk profile in AHSCT patients, the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) was developed [7,9] The HCT-CI included a larger number of pre-transplant comorbidities compared to CCI and provided a better predictability of transplant-related mortality (TRM) and overall survival (OS) [7,9]. Three studies investigated the incidence of comorbidities and their effects on transplant-related mortality in developing countries [12,19,20]. We aimed at evaluating, in a prospective study, the HCT-CI and the ACE-27 indexes as predictors of AHSCT complications in a Brazilian HSCT unit
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