Pretransplant Comorbidities Maintain Their Impact on Allogeneic Stem Cell Transplantation Outcome 5 Years Posttransplant: A Retrospective Study in a Single German Institution
The introduction of reduced-intensity conditioning regimens has allowed elderly patients with preexisting comorbidities access to the potentially curative allogeneic stem cell transplantation. Patient’s comorbidities at the time of treatment consideration play a significant role in transplant outcome in terms of both overall survival (OS) and nonrelapse mortality (NRM). The hematopoietic stem cell transplantation comorbidity index (HCT-CI) quantifies these patient specific risks and has established itself as a major tool in the pretransplant assessment of patients. Many single center and multicenter studies have assessed the HCT-CI score and reported conflicting outcomes. The present study aimed to evaluate the HCT-CI in a single large European transplant centre. 245 patients were retrospectively analyzed and the predictive value of the score was assessed with respect to OS and NRM. We confirm that the HCT-CI predicts outcome for both OS and NRM. Moreover, we identified age of the patient as an independent prognostic parameter for OS. Incorporation of age in the HCT-CI would improve its ability to prognosticate and allow the transplant physician to assess the patient specific risks appropriately at the time of counseling for transplant. 1. Introduction Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative therapeutic option for a variety of haematological malignancies [1]. As the average life expectancy increases each year, more and more elderly patients are diagnosed with cancer and therapeutic modalities need to be modified to cater the needs of this patient cohort. Conventional myeloablative conditioning regimens cannot be offered to patients above 55 with comorbidities due to its regimen related toxicities, resulting in turn in high nonrelapse mortality. Reduced intensity conditioning regimens take advantage of the graft-versus-leukemia (GvL) effect of the donor cells without eradicating the leukaemia clone with high dose therapy and offer a safer therapeutic option for this elderly cohort of patients [2, 3]. To balance treatment related risks with the influence of preexisting patient specific comorbidities [4] different assessment tools have been developed to guide patient counseling before allogeneic stem cell transplantation especially for elderly patients. The Charlson Comorbidity Index (CCI) has been used to predict treatment-related mortality (TRM) risks for various solid tumours by assigning weights for 19 chronic conditions based on their association with mortality [5, 6]. Lack of inclusion of significant comorbidities like
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