| Autor: |
Brian D. Friend, Larisa Broglie, Brent R. Logan, Saurabh Chhabra, Caitrin Bupp, Gary Schiller, Amer Beitinjaneh, Miguel Angel Diaz Perez, Gregory M.T. Guilcher, Hasan Hashem, Gerhard C. Hildebrandt, Maxwell M. Krem, Hillard M. Lazarus, Taiga Nishihori, Roomi Nusrat, Seth J. Rotz, Baldeep Wirk, Matthew Wieduwilt, Marcelo Pasquini, Bipin N. Savani, Edward A. Stadtmauer, Mohamed L. Sorror, Monica S. Thakar |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
Transplantation and cellular therapy. |
| ISSN: |
2666-6367 |
| Popis: |
Allogeneic hematopoietic cell transplantation is a curative procedure for hematologic malignancies but is associated with a significant risk of non-relapse mortality (NRM). The Hematopoietic Cell Transplantation- Comorbidity Index (HCT-CI) is a prognostic tool that discriminates this risk in all age groups. A recent survey of transplant physicians demonstrated that 79% of pediatric providers used the HCT-CI infrequently, and most reported concerns about its applicability in the younger population. We conducted a retrospective study using the Center for International Blood and Marrow Transplant Research (CIBMTR) database to examine the impact of expanded HCT-CI definitions on NRM in pediatric and young adult patients with hematologic malignancies. We included 5,790 patients40 years old receiving allogeneic transplant between 2008 and 2017 to examine broader definitions of comorbidities in the HCT-CI, including history of mechanical ventilation and fungal infection, estimated glomerular filtration rate (eGFR), and body mass index (BMI) percentiles. Multivariable Fine-Gray models were created to determine the effect of each HCT-CI defining comorbidity and its modification on NRM, and were utilized to develop two novel risk scores. We next developed the expanded HCT-CI for children and young adults (youth with malignancies; expanded ymHCT-CI), where 23% patients had an increased comorbidity score, compared to the HCT-CI. Comorbidities with hazard ratio (HR)1.2 were then removed to create the simplified HCT-CI for children and young adults (youth with malignancies; simplified ymHCT-CI), which demonstrated higher scores corresponded to a greater risk of NRM (p0.001). These novel comorbidity indices with broader definitions are more relevant to pediatric and young adult patients, and prospective studies are needed to validate these in the younger patient population. It remains to be seen if the development of these pediatric-specific and practical risk indices increases their utilization by the pediatric transplant community. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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