The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases

Monica S. Thakar, Larisa Broglie, Brent Logan, Andrew Artz, Nancy Bunin, Lauri M. Burroughs, Caitrin Fretham, David A. Jacobsohn, Alison W. Loren, Joanne Kurtzberg, Caridad A. Martinez, Shin Mineishi, Adam S. Nelson, Ann Woolfrey, Marcelo C. Pasquini, Mohamed L. Sorror

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Despite improvements, mortality after allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases remains a significant problem. We evaluated whether pre-HCT conditions defined by the HCT Comorbidity Index (HCT-CI) predict probability of post-transplant survival. Using the Center for International Blood and Marrow Transplant Research database, we identified 4083 patients with nonmalignant diseases transplanted between 2007 and 2014. Primary outcome was overall survival (OS) using the Kaplan-Meier method. Hazard ratios (HRs) were estimated by multivariable Cox regression models. Increasing HCT-CI scores translated to decreased 2-year OS of 82.7%, 80.3%, 74%, and 55.8% for patients with HCT-CI scores of 0, 1 to 2, 3 to 4, and ‡5, respectively, regardless of conditioning intensity. HCT-CI scores of 1 to 2 did not differ relative to scores of 0 (HR, 1.12 [95% CI, 0.93-1.34]), but HCT-CI of 3 to 4 and ‡5 posed significantly greater risks of mortality (HR, 1.33 [95% CI, 1.09-1.63]; and HR, 2.31 [95% CI, 1.79-2.96], respectively). The effect of HCT-CI differed by disease indication. Patients with acquired aplastic anemia, primary immune deficiencies, and congenital bone marrow failure syndromes with scores ‡3 had increased risk of death after HCT. However, higher HCT-CI scores among hemoglobinopathy patients did not increase mortality risk. In conclusion, this is the largest study to date reporting on patients with nonmalignant diseases demonstrating HCT-CI scores ‡3 that had inferior survival after HCT, except for patients with hemoglobinopathies. Our findings suggest that using the HCT-CI score, in addition to disease-specific factors, could be useful when developing treatment plans for nonmalignant diseases.

Original languageEnglish (US)
Pages (from-to)754-762
Number of pages9
JournalBlood
Volume133
Issue number7
DOIs
StatePublished - Feb 14 2019

Fingerprint

Transplants
Cell Transplantation
Comorbidity
Survival
Hazards
Hemoglobinopathies
Bone
Mortality
Blood
Aplastic Anemia
Proportional Hazards Models

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Thakar, M. S., Broglie, L., Logan, B., Artz, A., Bunin, N., Burroughs, L. M., ... Sorror, M. L. (2019). The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases. Blood, 133(7), 754-762. https://doi.org/10.1182/blood-2018-09-876284
Thakar, Monica S. ; Broglie, Larisa ; Logan, Brent ; Artz, Andrew ; Bunin, Nancy ; Burroughs, Lauri M. ; Fretham, Caitrin ; Jacobsohn, David A. ; Loren, Alison W. ; Kurtzberg, Joanne ; Martinez, Caridad A. ; Mineishi, Shin ; Nelson, Adam S. ; Woolfrey, Ann ; Pasquini, Marcelo C. ; Sorror, Mohamed L. / The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases. In: Blood. 2019 ; Vol. 133, No. 7. pp. 754-762.
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title = "The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases",
abstract = "Despite improvements, mortality after allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases remains a significant problem. We evaluated whether pre-HCT conditions defined by the HCT Comorbidity Index (HCT-CI) predict probability of post-transplant survival. Using the Center for International Blood and Marrow Transplant Research database, we identified 4083 patients with nonmalignant diseases transplanted between 2007 and 2014. Primary outcome was overall survival (OS) using the Kaplan-Meier method. Hazard ratios (HRs) were estimated by multivariable Cox regression models. Increasing HCT-CI scores translated to decreased 2-year OS of 82.7{\%}, 80.3{\%}, 74{\%}, and 55.8{\%} for patients with HCT-CI scores of 0, 1 to 2, 3 to 4, and ‡5, respectively, regardless of conditioning intensity. HCT-CI scores of 1 to 2 did not differ relative to scores of 0 (HR, 1.12 [95{\%} CI, 0.93-1.34]), but HCT-CI of 3 to 4 and ‡5 posed significantly greater risks of mortality (HR, 1.33 [95{\%} CI, 1.09-1.63]; and HR, 2.31 [95{\%} CI, 1.79-2.96], respectively). The effect of HCT-CI differed by disease indication. Patients with acquired aplastic anemia, primary immune deficiencies, and congenital bone marrow failure syndromes with scores ‡3 had increased risk of death after HCT. However, higher HCT-CI scores among hemoglobinopathy patients did not increase mortality risk. In conclusion, this is the largest study to date reporting on patients with nonmalignant diseases demonstrating HCT-CI scores ‡3 that had inferior survival after HCT, except for patients with hemoglobinopathies. Our findings suggest that using the HCT-CI score, in addition to disease-specific factors, could be useful when developing treatment plans for nonmalignant diseases.",
author = "Thakar, {Monica S.} and Larisa Broglie and Brent Logan and Andrew Artz and Nancy Bunin and Burroughs, {Lauri M.} and Caitrin Fretham and Jacobsohn, {David A.} and Loren, {Alison W.} and Joanne Kurtzberg and Martinez, {Caridad A.} and Shin Mineishi and Nelson, {Adam S.} and Ann Woolfrey and Pasquini, {Marcelo C.} and Sorror, {Mohamed L.}",
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Thakar, MS, Broglie, L, Logan, B, Artz, A, Bunin, N, Burroughs, LM, Fretham, C, Jacobsohn, DA, Loren, AW, Kurtzberg, J, Martinez, CA, Mineishi, S, Nelson, AS, Woolfrey, A, Pasquini, MC & Sorror, ML 2019, 'The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases', Blood, vol. 133, no. 7, pp. 754-762. https://doi.org/10.1182/blood-2018-09-876284

The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases. / Thakar, Monica S.; Broglie, Larisa; Logan, Brent; Artz, Andrew; Bunin, Nancy; Burroughs, Lauri M.; Fretham, Caitrin; Jacobsohn, David A.; Loren, Alison W.; Kurtzberg, Joanne; Martinez, Caridad A.; Mineishi, Shin; Nelson, Adam S.; Woolfrey, Ann; Pasquini, Marcelo C.; Sorror, Mohamed L.

In: Blood, Vol. 133, No. 7, 14.02.2019, p. 754-762.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Hematopoietic Cell Transplant Comorbidity Index predicts survival after allogeneic transplant for nonmalignant diseases

AU - Thakar, Monica S.

AU - Broglie, Larisa

AU - Logan, Brent

AU - Artz, Andrew

AU - Bunin, Nancy

AU - Burroughs, Lauri M.

AU - Fretham, Caitrin

AU - Jacobsohn, David A.

AU - Loren, Alison W.

AU - Kurtzberg, Joanne

AU - Martinez, Caridad A.

AU - Mineishi, Shin

AU - Nelson, Adam S.

AU - Woolfrey, Ann

AU - Pasquini, Marcelo C.

AU - Sorror, Mohamed L.

PY - 2019/2/14

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N2 - Despite improvements, mortality after allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases remains a significant problem. We evaluated whether pre-HCT conditions defined by the HCT Comorbidity Index (HCT-CI) predict probability of post-transplant survival. Using the Center for International Blood and Marrow Transplant Research database, we identified 4083 patients with nonmalignant diseases transplanted between 2007 and 2014. Primary outcome was overall survival (OS) using the Kaplan-Meier method. Hazard ratios (HRs) were estimated by multivariable Cox regression models. Increasing HCT-CI scores translated to decreased 2-year OS of 82.7%, 80.3%, 74%, and 55.8% for patients with HCT-CI scores of 0, 1 to 2, 3 to 4, and ‡5, respectively, regardless of conditioning intensity. HCT-CI scores of 1 to 2 did not differ relative to scores of 0 (HR, 1.12 [95% CI, 0.93-1.34]), but HCT-CI of 3 to 4 and ‡5 posed significantly greater risks of mortality (HR, 1.33 [95% CI, 1.09-1.63]; and HR, 2.31 [95% CI, 1.79-2.96], respectively). The effect of HCT-CI differed by disease indication. Patients with acquired aplastic anemia, primary immune deficiencies, and congenital bone marrow failure syndromes with scores ‡3 had increased risk of death after HCT. However, higher HCT-CI scores among hemoglobinopathy patients did not increase mortality risk. In conclusion, this is the largest study to date reporting on patients with nonmalignant diseases demonstrating HCT-CI scores ‡3 that had inferior survival after HCT, except for patients with hemoglobinopathies. Our findings suggest that using the HCT-CI score, in addition to disease-specific factors, could be useful when developing treatment plans for nonmalignant diseases.

AB - Despite improvements, mortality after allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases remains a significant problem. We evaluated whether pre-HCT conditions defined by the HCT Comorbidity Index (HCT-CI) predict probability of post-transplant survival. Using the Center for International Blood and Marrow Transplant Research database, we identified 4083 patients with nonmalignant diseases transplanted between 2007 and 2014. Primary outcome was overall survival (OS) using the Kaplan-Meier method. Hazard ratios (HRs) were estimated by multivariable Cox regression models. Increasing HCT-CI scores translated to decreased 2-year OS of 82.7%, 80.3%, 74%, and 55.8% for patients with HCT-CI scores of 0, 1 to 2, 3 to 4, and ‡5, respectively, regardless of conditioning intensity. HCT-CI scores of 1 to 2 did not differ relative to scores of 0 (HR, 1.12 [95% CI, 0.93-1.34]), but HCT-CI of 3 to 4 and ‡5 posed significantly greater risks of mortality (HR, 1.33 [95% CI, 1.09-1.63]; and HR, 2.31 [95% CI, 1.79-2.96], respectively). The effect of HCT-CI differed by disease indication. Patients with acquired aplastic anemia, primary immune deficiencies, and congenital bone marrow failure syndromes with scores ‡3 had increased risk of death after HCT. However, higher HCT-CI scores among hemoglobinopathy patients did not increase mortality risk. In conclusion, this is the largest study to date reporting on patients with nonmalignant diseases demonstrating HCT-CI scores ‡3 that had inferior survival after HCT, except for patients with hemoglobinopathies. Our findings suggest that using the HCT-CI score, in addition to disease-specific factors, could be useful when developing treatment plans for nonmalignant diseases.

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