Division of Hematology, University Hospital Basel, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Bone Marrow Transplant. 2024 Nov;59(11):1525-1533. doi: 10.1038/s41409-024-02395-z. Epub 2024 Aug 13.
The hematopoietic comorbidity risk index (HCT-CI) is a pre-transplant risk assessment tool used to qualify comorbidities to predict non-relapse mortality (NRM) of patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). HSCT procedures continue to improve. Therefore, the predictive value of HCT-CI needs to be re-evaluated. Our study is a retrospective analysis of pre-existing comorbidities assessing the relevance of the HCT-CI on the outcome of consecutive patients (n = 1102) undergoing allo-HSCT from 2006-2021. HCT-CI was classified as low (HCT-CI 0), intermediate (HCT-CI 1-2) and high-risk (HCT-CI ≥ 3). At 10 years, NRM for low, intermediate, and high-risk HCT-CI group was 21.0%, 26.0%, and 25.8% (p = 0.04). NRM difference was significant between low to intermediate (p < 0.001), but not between intermediate to high-risk HCT-CI (p = 0.22). Overall survival (OS) at 10 years differed significantly with 49.9%, 39.8%, and 31.1%, respectively (p < 0.001). In multivariate analysis of HCT-CI organ subgroups, cardiac disease was most strongly associated with NRM (HR = 1.73, p = 0.02) and OS (HR = 1.77, p < 0.001). All other individual organ comorbidities influenced NRM to a lesser extent. Further, donor (HR = 2.20, p < 0.001 for unrelated and HR = 2.17, p = 0.004 for mismatched related donor), disease status (HR = 1.41, p = 0.03 for advanced disease) and previous HSCT (HR = 1.55, p = 0.009) were associated with NRM. Improvement in transplant techniques and supportive care may have improved outcome with respect to comorbidities.
造血系统合并症风险指数（HCT-CI）是一种移植前风险评估工具，用于确定合并症以预测接受异基因造血干细胞移植（allo-HSCT）的患者的非复发死亡率（NRM）。HSCT 程序不断改进。因此，需要重新评估 HCT-CI 的预测价值。我们的研究是对既往合并症的回顾性分析，评估 HCT-CI 在连续接受 allo-HSCT 的患者（n=1102）结局中的相关性，这些患者于 2006 年至 2021 年接受治疗。HCT-CI 分为低危（HCT-CI 0）、中危（HCT-CI 1-2）和高危（HCT-CI≥3）。在 10 年时，低、中、高危 HCT-CI 组的 NRM 分别为 21.0%、26.0%和 25.8%（p=0.04）。低危与中危组之间的 NRM 差异有统计学意义（p<0.001），但中危与高危组之间无差异（p=0.22）。10 年时的总生存率（OS）分别显著为 49.9%、39.8%和 31.1%（p<0.001）。在 HCT-CI 器官亚组的多变量分析中，心脏病与 NRM（HR=1.73，p=0.02）和 OS（HR=1.77，p<0.001）的相关性最强。所有其他单个器官合并症对 NRM 的影响较小。此外，供体（无相关供体的 HR=2.20，p<0.001；匹配相关供体的 HR=2.17，p=0.004）、疾病状态（晚期疾病的 HR=1.41，p=0.03）和既往 HSCT（HR=1.55，p=0.009）与 NRM 相关。移植技术和支持性护理的改善可能改善了合并症的预后。
