Saeed Hayder, Yalamanchi Swati, Liu Meng, Van Meter Emily, Gul Zartash, Monohan Gregory, Howard Dianna, Hildebrandt Gerhard C, Herzig Roger
Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States.
Division of Hematology and Blood and Marrow Transplant, Markey Cancer Center, University of Kentucky, United States.
Hematol Oncol Stem Cell Ther. 2018 Jun;11(2):90-95. doi: 10.1016/j.hemonc.2017.12.002. Epub 2018 Feb 3.
Allogeneic hematopoietic stem cell transplant (HCT) continues to evolve with the treatment in higher risk patient population. This practice mandates stringent update and validation of risk stratification prior to undergoing such a complex and potentially fatal procedure. We examined the adoption of the new comorbidity index (HCT-CI/Age) proposed by the Seattle group after the addition of age variable and compared it to the pre-transplant assessment of mortality (PAM) that already incorporates age as part of its evaluation criteria.
A retrospective analysis of adult patients who underwent HCT at our institution from January 2010 through August 2014 was performed. Kaplan-Meier's curve, log-rank tests, Cox model and Pearson correlation was used in the analysis.
Of the 114 patients that underwent allogeneic transplant in our institution, 75.4% were ≥40 years old. More than 58% had a DLCO ≤80%. Although scores were positively correlated (correlation coefficient 0.43, p < 0.001), HCT-CI/Age more accurately predicted 2-year overall survival (OS) and non-relapse mortality (NRM) in patients with lower (0-4) and higher (5-7) scores (52% and 36% versus 24% and 76%, p = 0.004, 0.003 respectively). PAM score did not reach statistical significance for difference in OS nor NRM between the low (<24) and high-risk (≥24) groups (p = 0.19 for both).
Despite our small sample population, HCT-CI/Age was more discriminative to identify patients with poor outcome that might benefit from intensified management strategies or other therapeutic approaches rather than allogeneic HCT.
异基因造血干细胞移植（HCT）在高危患者群体的治疗中不断发展。在进行这种复杂且可能致命的手术之前，这种做法要求对风险分层进行严格更新和验证。我们研究了西雅图小组提出的新合并症指数（HCT-CI/年龄）在加入年龄变量后的应用情况，并将其与已将年龄纳入评估标准的移植前死亡率评估（PAM）进行比较。
对2010年1月至2014年8月在我们机构接受HCT的成年患者进行回顾性分析。分析中使用了Kaplan-Meier曲线、对数秩检验、Cox模型和Pearson相关性分析。
在我们机构接受异基因移植的114例患者中，75.4%的患者年龄≥40岁。超过58%的患者DLCO≤80%。尽管评分呈正相关（相关系数0.43，p<0.001），但HCT-CI/年龄能更准确地预测低评分（0-4分）和高评分（5-7分）患者的2年总生存率（OS）和非复发死亡率（NRM）（分别为52%和36%，而PAM为24%和76%，p分别为0.004和0.003）。低风险（<24分）和高风险（≥24分）组之间，PAM评分在OS和NRM差异方面未达到统计学意义（两者p均为0.19）。
尽管我们的样本量较小，但HCT-CI/年龄在识别可能从强化管理策略或其他治疗方法而非异基因HCT中获益的预后不良患者方面更具鉴别力。
