Michelis Fotios V, Messner Hans A, Uhm Jieun, Alam Naheed, Lambie Anna, McGillis Laura, Seftel Matthew D, Gupta Vikas, Kuruvilla John, Lipton Jeffrey H, Kim Dennis Dong Hwan
Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Allogeneic Blood and Marrow Transplant Program, Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Clin Lymphoma Myeloma Leuk. 2015 May;15(5):e73-81. doi: 10.1016/j.clml.2014.09.014. Epub 2014 Oct 5.
Risk scores have been developed for allogeneic hematopoietic cell transplantation (HCT) outcomes, such as the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) and the modified European Group for Blood and Marrow Transplantation risk score (mEBMT) for acute leukemia. We investigated the influence of these scores for 350 patients who underwent transplantation for acute myeloid leukemia (AML).
The HCT-CI scores were grouped as 0 to 2 and ≥ 3 (231 and 119 patients, respectively) and the mEBMT scores as 0 to 2 and ≥ 3 (166 and 184 patients, respectively).
Univariate analysis showed a significant association between the HCT-CI score and overall survival (OS) (P = .01), as did the mEBMT score (P = .002). The 5-year OS rate was 50% and 34% for a mEBMT score of 0 to 2 and ≥ 3, respectively. A subgroup of patients with a mEBMT score of 0 to 1 (n = 32) demonstrated a favorable OS of 75% at 5 years. This subgroup was younger (median age, 31 years), in first remission at transplantation, and had related donors. For the HCT-CI, the 5-year OS was 46% and 34% for a score of 0 to 2 and ≥ 3, respectively. Patients with an HCT-CI score of 0 (n = 94) had a 5-year OS of 44%. Multivariable analysis confirmed both the HCT-CI score and the mEBMT score, as previously grouped, as independent prognostic variables for both OS (P = .02 and P = .001, respectively) and nonrelapse mortality (NRM) (P = .01 and P = .003, respectively).
The results of the present study have demonstrated that the HCT-CI and mEBMT are both prognostic for OS and NRM in our cohort. However, the mEBMT score can identify a favorable-risk subgroup of patients not identifiable using the HCT-CI.
已针对异基因造血细胞移植（HCT）的预后制定了风险评分，例如造血细胞移植合并症指数（HCT-CI）以及用于急性白血病的改良欧洲血液和骨髓移植组风险评分（mEBMT）。我们调查了这些评分对350例接受急性髓细胞白血病（AML）移植患者的影响。
HCT-CI评分分为0至2分和≥3分（分别为231例和119例患者），mEBMT评分分为0至2分和≥3分（分别为166例和184例患者）。
单因素分析显示HCT-CI评分与总生存期（OS）之间存在显著关联（P = 0.01），mEBMT评分亦是如此（P = 0.002）。mEBMT评分为0至2分和≥3分的患者5年总生存率分别为50%和34%。mEBMT评分为0至1分的一组患者（n = 32）5年总生存率达75%，预后良好。该亚组患者较年轻（中位年龄31岁），移植时处于首次缓解期，且有相关供者。对于HCT-CI，评分为0至2分和≥3分的患者5年总生存率分别为46%和34%。HCT-CI评分为0分的患者（n = 94）5年总生存率为44%。多因素分析证实，如之前分组的HCT-CI评分和mEBMT评分，均为OS（分别为P = 0.02和P = 0.001）和非复发死亡率（NRM）（分别为P = 0.01和P = 0.003）的独立预后变量。
本研究结果表明，HCT-CI和mEBMT对我们队列中的OS和NRM均具有预后价值。然而，mEBMT评分能够识别出使用HCT-CI无法识别的低风险亚组患者。
