Effect of comorbidities on hematopoietic stem cell transplantation outcome in adult patients with different hematologic diseases: a single-center experience in Egypt

Abstract

Background Hematopoietic stem cell transplantation (HSCT) is a procedure that can restore marrow function in patients who have had severe marrow injury. It is either autologous or allogeneic. It has become increasingly important to optimize pretransplant risk assessment to improve hematopoietic cell transplantation (HCT) decision making. Single-organ comorbidity involving the liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality compared with other non-HCT-specific indexes. Aim The aim of this study was to investigate the impact of various pretransplant comorbidities on the outcome of patients who had undergone either allogeneic or autologous HSCT in relation to treatment-related mortality, disease-related mortality, and overall survival. Patients and methods A retrospective study was conducted at the Bone Marrow Transplantation Unit, Ain Shams University, on 119 patients who were transplanted either using autologous or allogeneic HSCT. All of them were older than 18 years and had different types of hematologic diseases. The most frequent hematologic disease was acute myeloid leukemia (34.4%), followed by multiple myeloma (17.6%), acute lymphoblastic leukemia (16.8%), and lymphoma (10.9%), whereas aplastic anemia, myelodysplastic syndrome, chronic myeloid leukemia, and biphenotypic leukemia collectively represented 20.1%. They were either incomplete or partial remission. They were categorized on the basis of the HCT-CI as follows: mild score (0), 43 (36.2%) patients; moderate score (1-2), 60 (50.4%) patients; and severe score (΃3), 16 (13.4%) patients. The study data were collected from medical notes, pathology reports, and laboratory data. Results There was a statistically significant relation between the HCT-CI and overall survival ( P = 0.012), disease-free survival ( P = 0.007), mortality ( P = 0.047), and the incidence of graft failure ( P = 0.034). Conclusion We concluded that the HCT-CI is a better predictor for detecting the influence of comorbidity in patients with hematologic disorders on mortality, overall survival, and disease-free survival after HCT.