Pre-transplant Comorbidities: Influence on Decision-Making and Outcomes
| Autor: | Mohamed L. Sorror, Ahmed H. Rashad, Shirali Agarwal, Jennifer E. Nyland |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Hematopoietic cell business.industry Transplantation surgical procedures operative Increased risk Quality of life immune system diseases hemic and lymphatic diseases medicine Intensive care medicine Autologous transplant business Adverse effect Organ system Comorbidity index |
| Zdroj: | Supportive Care Strategies ISBN: 9783319590134 |
| DOI: | 10.1007/978-3-319-59014-1_5 |
| Popis: | The advent of allogeneic hematopoietic cell transplantation (allo-HCT) brought potential cures to a large number of malignant and non-malignant hematological disorders. Unfortunately, the curative benefits associated with allo-HCT are eclipsed by an increased risk of adverse effects on organ systems. Comorbidities present at the time of transplantation also adversely influence post-transplant outcomes. Combined, these risks complicate patient selection for allo-HCT. To account for this, the HCT comorbidity index (HCT-CI) was developed to predict post-transplant complications, organ toxicities, and acute and chronic graft-versus-host-disease (GVHD), as well as transplant outcomes like morbidity, mortality, and quality of life. The HCT-CI has been verified to be a clinically meaningful tool for the stratification of risk prior to transplant. The predictive power of the HCT-CI can be augmented by the addition of patient- and/or disease-specific risk factors and further expanded by analyzing its utility in conjunction with other available indices. Here we describe the impact of comorbidities on transplant outcomes, the development of comorbidity-specific prediction models, other composite models, their application to guide decision-making, the use of the HCT-CI for autologous transplant, and future directions to refine strategies of predicting post-transplant outcomes. |
| Databáze: | OpenAIRE |
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