Assessment of Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) As a Predictor for Higher Level of Care after Discharge for Patients Undergoing Autologous Stem Cell Transplantation for Multiple Myeloma and Lymphoma

Abstract

Introduction Hematopoietic cell transplantation-specific comorbidity index (HCT-CI) is a validated scoring system that assesses the risks of patients (pts) undergoing allogenic stem cell transplant. [Sorror et al. 2005] There has been emerging evidence of its value in risk discussion for pts undergoing autologous stem cell transplantation (ASCT). In a recent large (N=1730) retrospective study in pts with multiple myeloma (MM) or lymphoma, a high-risk HCT-CI was associated with higher rates of orotracheal intubation (OTI), 100-day non-relapsed mortality (NRM), and 1-year mortality. [Berro et al. 2017] Not well studied was disposition of a pt at the time of discharge post-transplant as it relates to HCT-CI risk. This could be an additional useful variable in pts/caregiver discussions pre-ASCT. Herein, we report a retrospective single institution review of our experience as it relates to HCT-CI to post-ASCT outcomes including level of care requirements at time of discharge. Methods We performed a retrospective review of pts with MM or lymphoma who received consolidative ASCT between May 2013 and March 2018. Pt demographic were collected. Pts HCT-CI were collected per defined variables by Sorror et al. Each pt was divided into three cohorts: low risk (HCT-CI score of 0), intermediate risk (HCT-CI score of 1-2), and high risk (HCT-CI ≥ 3). Discharge location was categorized into five dispositions: home with caregiver, home with supplemental care, skilled nursing facility, acute rehab facility, and died during transplant. Results Four hundred sixty-one charts were reviewed. Males were 62.0% of the population with a median age of 58.5. Disease populations were balanced with MM/lymphoma at 48.4%/51.6% respectively. MM pts received melphalan (140 or 200 mm/m2) and lymphomas received BEAM based conditioning. We found no statistical correlation of high-risk HCT-CI patients requiring higher rates of OTI during ASCT (p=0.1066) nor requiring a higher level of care post-ASCT transplant (p=0.2998). Furthermore we were unable to statistically correlate high-risk HCT-CI score with an increased rates of 100-day NRM (p=0.0681) or 1-year mortality (p=0.0656). We further investigated the breakdown of HCT-CI scoring of high-risk pts (n=177). The dominant comorbid conditions that appeared to be driving points towards a high-risk designation was cardiopulmonary (70.5%) and psychiatric (34.5%). Conclusion In our single center experience the categorization of high-risk HCT-CI prior to ASCT did not portend a higher risk with regards to OTI, 100-day NRM, or 1-year NRM when compared to pts categorized as low and intermediate risk in ASCT. A high risk HCT-CI score did not predict for a statistically significant increase in need for higher level of care post ASCT beyond caregiver support.