Penack Olaf, Peczynski Christophe, Mohty Mohamad, Yakoub-Agha Ibrahim, de la Camara Rafael, Glass Bertram, Duarte Rafael F, Kröger Nicolaus, Schoemans Hélène, Koenecke Christian, Peric Zinaida, Basak Grzegorz W
Medical Clinic, Department of Haematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
EBMT Transplant Complications Working Party, Paris, France.
Bone Marrow Transplant. 2022 Feb;57(2):183-190. doi: 10.1038/s41409-021-01502-8. Epub 2021 Oct 30.
Risk assessment of allogeneic hematopoietic cell transplantation (allo-HCT) is hindered by the lack of current data on comorbidities and outcome. The EBMT identified 38,760 allo-HCT recipients with hematologic malignancies transplanted between 2010 and 2018 from matched sibling and unrelated donors with a full data set of pre-existing comorbidities. Multivariate analyses using the Cox proportional-hazards model including known risk factors for non-relapse mortality (NRM) were performed. We found that pre-existing renal comorbidity had the strongest association with NRM (hazard ratio [HR] 1.85 [95% CI 1.55-2.19]). In addition, the association of multiple pre-existing comorbidities with NRM was significant, including diabetes, infections, cardiac comorbidity, and pulmonary comorbidity. However, the HR of the association of these comorbidities with NRM was relatively low and did not exceed 1.24. Consequently, the risk of NRM was only moderately increased in patients with a high hematopoietic cell transplantation comorbidity index (HCT-CI) ≥ 3 (HR 1.34 [1.26-1.42]). In the current EBMT population, pre-existing non-renal comorbidities determined NRM after allo-HCT to a much lesser extent as compared with the underlying HCT-CI data. Improvements in management and supportive care as well as higher awareness based on the use of HCT-CI may have contributed to this favorable development.
由于缺乏关于合并症和预后的现有数据，异基因造血细胞移植（allo-HCT）的风险评估受到阻碍。欧洲血液与骨髓移植学会（EBMT）确定了38760例接受异基因造血细胞移植的血液系统恶性肿瘤患者，这些患者于2010年至2018年间接受了来自匹配同胞和无关供体的移植，且有完整的既往合并症数据集。使用Cox比例风险模型进行多变量分析，该模型包括已知的非复发死亡率（NRM）风险因素。我们发现，既往存在的肾脏合并症与NRM的关联最强（风险比[HR]为1.85[95%置信区间1.55 - 2.19]）。此外，多种既往合并症与NRM的关联显著，包括糖尿病、感染、心脏合并症和肺部合并症。然而，这些合并症与NRM关联的HR相对较低，未超过1.24。因此，造血细胞移植合并症指数（HCT-CI）≥3的患者发生NRM的风险仅适度增加（HR 1.34[1.26 - 1.42]）。在当前EBMT人群中，与基础HCT-CI数据相比，既往存在的非肾脏合并症对异基因造血细胞移植后NRM的影响要小得多。管理和支持治疗的改善以及基于HCT-CI使用的更高认识可能促成了这一良好进展。
