The Simplified Comorbidity Index: a new tool for prediction of nonrelapse mortality in allo-HCT.

Autor:	Shouval R; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.; Department of Medicine, Weill Cornell Medical College, New York, NY., Fein JA; Department of Medicine, University of Connecticut Medical Center, Farmington, CT., Cho C; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Avecilla ST; Department of Laboratory Medicine., Ruiz J; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Tomas AA; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Sanchez-Escamilla M; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Flores NC; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Yáñez L; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY., Barker JN; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Dahi P; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Giralt SA; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Geyer AI; Department of Medicine, Weill Cornell Medical College, New York, NY.; Pulmonary Service, Department of Medicine., Gyurkocza B; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Jakubowski AA; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Lin RJ; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., O'Reilly RJ; Department of Medicine, Weill Cornell Medical College, New York, NY.; Bone Marrow Transplant Service, Department of Pediatrics, and., Papadopoulos EB; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Politikos I; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Ponce DM; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Sauter CS; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Scordo M; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Shaffer B; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Shah GL; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Sullivan JP; Pulmonary Service, Department of Medicine., Tamari R; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., van den Brink MRM; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Young JW; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY., Nagler A; Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel., Devlin S; Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY., Shimoni A; Department of Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Israel., Perales MA; Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.; Department of Medicine, Weill Cornell Medical College, New York, NY.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2022 Mar 08; Vol. 6 (5), pp. 1525-1535.
DOI:	10.1182/bloodadvances.2021004319
Abstrakt:	Individual comorbidities have distinct contributions to nonrelapse mortality (NRM) following allogeneic hematopoietic cell transplantation (allo-HCT). We studied the impact of comorbidities individually and in combination in a single-center cohort of 573 adult patients who underwent CD34-selected allo-HCT following myeloablative conditioning. Pulmonary disease, moderate to severe hepatic comorbidity, cardiac disease of any type, and renal dysfunction were associated with increased NRM in multivariable Cox regression models. A Simplified Comorbidity Index (SCI) composed of the 4 comorbidities predictive of NRM, as well as age >60 years, stratified patients into 5 groups with a stepwise increase in NRM. NRM rates ranged from 11.4% to 49.9% by stratum, with adjusted hazard ratios of 1.84, 2.59, 3.57, and 5.38. The SCI was also applicable in an external cohort of 230 patients who underwent allo-HCT with unmanipulated grafts following intermediate-intensity conditioning. The area under the receiver operating characteristic curve (AUC) of the SCI for 1-year NRM was 70.3 and 72.0 over the development and external-validation cohorts, respectively; corresponding AUCs of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) were 61.7 and 65.7. In summary, a small set of comorbidities, aggregated into the SCI, is highly predictive of NRM. The new index stratifies patients into distinct risk groups, was validated in an external cohort, and provides higher discrimination than does the HCT-CI. (© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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