Wolff Daniel, Herzberg Philipp Y, Herrmann Anne, Pavletic Steven Z, Heussner Pia, Mumm Friederike, Höfer Christina, Hilgendorf Inken, Hemmati Philipp G, Holler Ernst, Greinix Hildegard, Mitchell Sandra A
Department of Internal Medicine III, University Hospital of Regensburg, Regensburg, Germany.
Faculty of Humanities and Social Sciences, Personality Psychology and Psychological Assessment, Helmut Schmidt University of the Federal Armed Forces Hamburg, Hamburg, Germany.
Bone Marrow Transplant. 2021 Jan;56(1):243-256. doi: 10.1038/s41409-020-01017-8. Epub 2020 Jul 31.
Comorbidity after allogeneic hematopoietic stem cell transplantation (alloHSCT) impairs quality of life (QoL), physical functioning, and survival. We developed a new standardized measure to capture comorbidity after transplantation, the Post-transplant Multimorbidity Index (PTMI) in a cohort of 50 long term survivors. We subsequently evaluated the content validity and impact on survival and QoL within a multicenter trial, including 208 patients (pts) after alloHSCT, who were prospectively evaluated applying the FACT-BMT, the Human Activity Profile (HAP), the SF-36 v.2, PTMI and the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI). The most prevalent comorbidities were compensated arterial hypertension (28.4%), ambulatory infections (25.5%), iron overload (23%), mild renal function impairment (20%), and osteoporosis (13%). Applying the PTMI 13% of patients had no comorbidity, while 37.1% had 1-3 comorbidities, 27.4% had 4-6 comorbidities, and 13.5% had > 6 comorbidities. Chronic graft-versus-host disease (cGvHD) was significantly associated with the PTMI, while age and prior acute GvHD were not. In contrast, the HCT-CI was not associated with the presence of cGvHD. cGvHD was significantly associated with depression (r = 0.16), neurological disease (r = 0.21), osteoporosis (r = 0.18) and nonmelanoma skin cancer (r = 0.26). The PTMI demonstrated strong measurement properties and compared to the HCT-CI captured a wider range of comorbidities associated with cGvHD.
异基因造血干细胞移植（alloHSCT）后的合并症会损害生活质量（QoL）、身体机能和生存率。我们开发了一种新的标准化方法来评估移植后的合并症，即移植后多重合并症指数（PTMI），该方法应用于50名长期存活者队列。随后，我们在一项多中心试验中评估了其内容效度以及对生存率和生活质量的影响，该试验纳入了208例alloHSCT术后患者，对他们前瞻性地应用了FACT - BMT、人类活动概况（HAP）、SF - 36 v.2、PTMI和造血细胞移植合并症指数（HCT - CI）进行评估。最常见的合并症为代偿性动脉高血压（28.4%）、非卧床感染（25.5%）、铁过载（23%）、轻度肾功能损害（20%）和骨质疏松（13%）。应用PTMI评估，13%的患者无合并症，37.1%的患者有1 - 3种合并症，27.4%的患者有4 - 6种合并症，13.5%的患者有超过6种合并症。慢性移植物抗宿主病（cGvHD）与PTMI显著相关，而年龄和既往急性移植物抗宿主病则无此关联。相比之下，HCT - CI与cGvHD的存在无关。cGvHD与抑郁（r = 0.16）、神经疾病（r = 0.21）、骨质疏松（r = 0.18）和非黑色素瘤皮肤癌（r = 0.26）显著相关。PTMI显示出强大的测量特性，与HCT - CI相比，它涵盖了更广泛的与cGvHD相关的合并症。
