TY - JOUR
T1 - The Simplified Comorbidity Index
T2 - a new tool for prediction of nonrelapse mortality in allo-HCT
AU - Shouval, Roni
AU - Fein, Joshua A.
AU - Cho, Christina
AU - Avecilla, Scott T.
AU - Ruiz, Josel
AU - Tomas, Ana Alarcon
AU - Sanchez-Escamilla, Miriam
AU - Flores, Nerea Castillo
AU - Yañez, Lucrecia
AU - Barker, Juliet N.
AU - Dahi, Parastoo
AU - Giralt, Sergio A.
AU - Geyer, Alexander I.
AU - Gyurkocza, Boglarka
AU - Jakubowski, Ann A.
AU - Lin, Richard J.
AU - O’Reilly, Richard J.
AU - Papadopoulos, Esperanza B.
AU - Politikos, Ioannis
AU - Ponce, Doris M.
AU - Sauter, Craig S.
AU - Scordo, Miccohael
AU - Shaffer, Brian
AU - Shah, Gunjan L.
AU - Sullivan, James P.
AU - Tamari, Roni
AU - van den Brink, Marcel R.M.
AU - Young, James W.
AU - Nagler, Arnon
AU - Devlin, Sean
AU - Shimoni, Avichai
AU - Perales, Miguel Angel
N1 - Publisher Copyright:
ß 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.
PY - 2022/3/8
Y1 - 2022/3/8
N2 - Individual comorbidities have distinct contributions to nonrelapse mortality (NRM) following allogeneic hematopoietic cell transplantation (allo-HCT). We studied the impact of comorbidities individually and in combination in a single-center cohort of 573 adult patients who underwent CD34-selected allo-HCT following myeloablative conditioning. Pulmonary disease, moderate to severe hepatic comorbidity, cardiac disease of any type, and renal dysfunction were associated with increased NRM in multivariable Cox regression models. A Simplified Comorbidity Index (SCI) composed of the 4 comorbidities predictive of NRM, as well as age >60 years, stratified patients into 5 groups with a stepwise increase in NRM. NRM rates ranged from 11.4% to 49.9% by stratum, with adjusted hazard ratios of 1.84, 2.59, 3.57, and 5.38. The SCI was also applicable in an external cohort of 230 patients who underwent allo-HCT with unmanipulated grafts following intermediate-intensity conditioning. The area under the receiver operating characteristic curve (AUC) of the SCI for 1-year NRM was 70.3 and 72.0 over the development and external-validation cohorts, respectively; corresponding AUCs of the Hematopoietic Cell Transplantation–specific Comorbidity Index (HCT-CI) were 61.7 and 65.7. In summary, a small set of comorbidities, aggregated into the SCI, is highly predictive of NRM. The new index stratifies patients into distinct risk groups, was validated in an external cohort, and provides higher discrimination than does the HCT-CI.
AB - Individual comorbidities have distinct contributions to nonrelapse mortality (NRM) following allogeneic hematopoietic cell transplantation (allo-HCT). We studied the impact of comorbidities individually and in combination in a single-center cohort of 573 adult patients who underwent CD34-selected allo-HCT following myeloablative conditioning. Pulmonary disease, moderate to severe hepatic comorbidity, cardiac disease of any type, and renal dysfunction were associated with increased NRM in multivariable Cox regression models. A Simplified Comorbidity Index (SCI) composed of the 4 comorbidities predictive of NRM, as well as age >60 years, stratified patients into 5 groups with a stepwise increase in NRM. NRM rates ranged from 11.4% to 49.9% by stratum, with adjusted hazard ratios of 1.84, 2.59, 3.57, and 5.38. The SCI was also applicable in an external cohort of 230 patients who underwent allo-HCT with unmanipulated grafts following intermediate-intensity conditioning. The area under the receiver operating characteristic curve (AUC) of the SCI for 1-year NRM was 70.3 and 72.0 over the development and external-validation cohorts, respectively; corresponding AUCs of the Hematopoietic Cell Transplantation–specific Comorbidity Index (HCT-CI) were 61.7 and 65.7. In summary, a small set of comorbidities, aggregated into the SCI, is highly predictive of NRM. The new index stratifies patients into distinct risk groups, was validated in an external cohort, and provides higher discrimination than does the HCT-CI.
UR - http://www.scopus.com/inward/record.url?scp=85126144018&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2021004319
DO - 10.1182/bloodadvances.2021004319
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C2 - 34507354
AN - SCOPUS:85126144018
SN - 2473-9529
VL - 6
SP - 1525
EP - 1535
JO - Blood advances
JF - Blood advances
IS - 5
ER -