Farina L, Bruno B, Patriarca F, Spina F, Sorasio R, Morelli M, Fanin R, Boccadoro M, Corradini P
Hematology Department, IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
Leukemia. 2009 Jun;23(6):1131-8. doi: 10.1038/leu.2009.1. Epub 2009 Feb 5.
The hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been developed to identify patients at high risk of mortality after an allograft. Reduced-intensity/non-myeloablative regimens have decreased the non-relapse mortality (NRM) in elderly and/or heavily pretreated patients. We performed a retrospective study to assess whether HCT-CI may predict clinical outcomes in a cohort of 203 patients with non-Hodgkin's (NHL; n=108), Hodgkin's lymphomas (HL; n=26), and multiple myeloma (MM; n=69), who were transplanted from a human leucocyte antigen (HLA)-matched sibling (n=121) or an unrelated donor (n=82) after a reduced-intensity regimen (n=154) or a low-dose total body irradiation-based non-myeloblative regimen (n=49). Cumulative incidence of NRM was 5, 16 and 20% at 1 year and 6, 24 and 27% at 2 years, for patients with an HCT-CI of 0, 1-2 and > or =3, respectively. By multivariate analysis, HCT-CI significantly predicted NRM (hazard ratio (HR)=1.6, P=0.03), overall survival (OS; HR=1.62, P<0.001) and progression-free survival (PFS; HR=1.43, P=0.002). Moreover, the Karnofsky performance status was also significantly associated with OS and NRM (HR=1.62, P<0.001 and HR=2.12, P=0.04, respectively). Conditioning type did not affect outcome after stratifying patients by HCT-CI. In the light of our study, all future prospective trials of the Gruppo Italiano Trapianti di Midollo (GITMO) will include the HCT-CI to stratify patients.
造血细胞移植特异性合并症指数（HCT-CI）已被用于识别同种异体移植后死亡风险较高的患者。降低强度/非清髓性方案降低了老年和/或预处理严重患者的非复发死亡率（NRM）。我们进行了一项回顾性研究，以评估HCT-CI是否可以预测203例非霍奇金淋巴瘤（NHL；n = 108）、霍奇金淋巴瘤（HL；n = 26）和多发性骨髓瘤（MM；n = 69）患者的临床结局，这些患者在接受降低强度方案（n = 154）或基于低剂量全身照射的非清髓性方案（n = 49）后，接受了来自人类白细胞抗原（HLA）匹配的同胞供者（n = 121）或无关供者（n = 82）的移植。HCT-CI分别为0、1 - 2和≥3的患者，NRM的1年累积发生率分别为5%、16%和20%，2年累积发生率分别为6%、24%和27%。通过多因素分析，HCT-CI显著预测NRM（风险比（HR）= 1.6，P = 0.03）、总生存期（OS；HR = 1.62，P < 0.001）和无进展生存期（PFS；HR = 1.43，P = 0.002）。此外，卡诺夫斯基体能状态也与OS和NRM显著相关（HR分别为1.62，P < 0.001和HR = 2.12，P = 0.04）。在根据HCT-CI对患者进行分层后，预处理类型不影响结局。根据我们的研究，意大利骨髓移植协作组（GITMO）未来所有的前瞻性试验都将纳入HCT-CI以对患者进行分层。
