Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington; Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington; Department of Blood Diseases, Angers University Hospital, Angers, France; Grand Ouest Against Leukemia (GOAL), Angers, France; University of Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, Angers, France.
Nutrition Therapy, University of Washington Medical Center, Seattle, Washington.
Transplant Cell Ther. 2022 Dec;28(12):846.e1-846.e9. doi: 10.1016/j.jtct.2022.09.023. Epub 2022 Sep 28.
Pretransplantation nutritional status may impact outcome after allogeneic hematopoietic cell transplantation (HCT). Various simple screening tools have been developed and used to identify patients at risk of malnutrition; however, how best to use these screening tools is unclear, and their accuracy for the prediction of adverse outcomes is unknown. To investigate how these different measures contribute to outcome prediction, we examined a large cohort of adults with acute myelogenous leukemia (AML) who underwent allogeneic HCT in first or second remission at our institution between April 2006 and May 2021. We assessed the prognostic role of the Nutrition Risk Index (NRI), which combines weight loss and serum albumin, in 970 adults with AML in first or second remission who had usual body weight information available at AML diagnosis or relapse and before HCT. A low NRI at the time of conditioning for HCT was associated with higher nonrelapse mortality (hazard ratio [HR], .97; 95% confidence interval [CI], .95 to .98; P < .001) and relapse risk (HR, .98; 95% CI, .96 to .99; P < .001) and decreased relapse-free survival (HR, .97; 95% CI, .96 to .98; P < .001) and overall survival (HR, .97; 95% CI, .96 to .98; P < .001), as was a low pre-HCT serum albumin level. After multivariable adjustment, NRI, but not weight loss alone, was associated with outcome. The predictive ability of NRI was overall relatively low and comparable to that of serum albumin, with a C-statistic not exceeding .59. Taken together, our data indicate that pre-HCT level of serum albumin, an acute-phase protein recognized to more accurately reflect the severity of the inflammatory response compared with poor nutritional status, but not weight loss, is independently associated with post-HCT outcome in patients with AML. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
移植前的营养状况可能会影响异基因造血细胞移植（HCT）后的结果。已经开发并使用了各种简单的筛选工具来识别有营养不良风险的患者；然而，如何最好地使用这些筛选工具尚不清楚，其对不良结果的预测准确性也未知。为了研究这些不同的措施如何有助于预测结果，我们检查了在我们机构接受首次或第二次缓解的急性髓细胞性白血病（AML）成人患者的大型队列。我们评估了营养风险指数（NRI）的预后作用，该指数结合了体重减轻和血清白蛋白，纳入了在 AML 诊断或复发时以及在 HCT 前有正常体重信息的 970 名首次或第二次缓解的 AML 成人患者。在进行 HCT 预处理时，NRI 较低与较高的非复发死亡率（风险比[HR]，0.97；95%置信区间[CI]，0.95 至 0.98；P<.001）和复发风险（HR，0.98；95%CI，0.96 至 0.99；P<.001）以及较低的无复发生存率（HR，0.97；95%CI，0.96 至 0.98；P<.001）和总生存率（HR，0.97；95%CI，0.96 至 0.98；P<.001）相关，且 HCT 前血清白蛋白水平较低。在多变量调整后，NRI，而不是单独的体重减轻，与结局相关。NRI 的预测能力总体上相对较低，与血清白蛋白相当，C 统计量不超过 0.59。总的来说，我们的数据表明，HCT 前血清白蛋白水平，一种与营养状况相比更能准确反映炎症反应严重程度的急性期蛋白，但不是体重减轻，与 AML 患者的 HCT 后结局独立相关。
