Fred Hutchinson Cancer Research Center.
Mediterr J Hematol Infect Dis. 2010;2(2):e2010015. doi: 10.4084/MJHID.2010.015. Epub 2010 Jun 9.
Allogeneic conventional hematopoietic cell transplantation (HCT) following high-dose, myeloablative conditioning regimens has been used since the 1970's as potentially curative treatment for patients with malignant, hematological disorders. The toxicities of conditioning regimens have limited conventional HCT to relatively young patients in otherwise good medical condition. With the development of less toxic nonmyeloablative regimens and improvements in supportive care, increasing numbers of older and medically infirm patients have been treated by allogeneic HCT. Until recently, there has been almost no effort to evaluate the prevalence of comorbidities among HCT recipients and their impact on outcomes. We first evaluated the Charlson Comorbidity Index (CCI) developed for patients with solid malignancies, for this purpose. While useful, it lacked sensitivity and specificity for the HCT setting. We next introduced the HCT-specific comorbidity index (HCT-CI) which was based on objective laboratory data to better define comorbidities. Here, we describe this development and illustrate the usefulness of the HCT-CI in predicting HCT outcomes in patients with myeloid and lymphoid malignancies undergoing allogeneic transplantation.
自 20 世纪 70 年代以来，大剂量、清髓性预处理方案的异基因常规造血细胞移植（HCT）已被用作恶性血液病患者的潜在治愈性治疗方法。预处理方案的毒性限制了常规 HCT 仅适用于身体状况良好的相对年轻的患者。随着非清髓性方案毒性降低和支持性护理的改善，越来越多的老年和体弱患者接受了异基因 HCT 治疗。直到最近，几乎没有努力评估 HCT 受者合并症的流行情况及其对结局的影响。我们首先评估了专为实体恶性肿瘤患者开发的 Charlson 合并症指数（CCI），用于此目的。虽然有用，但它对 HCT 环境缺乏敏感性和特异性。我们接下来引入了基于客观实验室数据的 HCT 特异性合并症指数（HCT-CI），以更好地定义合并症。在这里，我们描述了这种发展，并说明了 HCT-CI 在预测接受异基因移植的髓系和淋巴系恶性肿瘤患者 HCT 结局中的有用性。
