Combination of the Hematopoietic Cell Transplantation Comorbidity Index and the European Group for Blood and Marrow Transplantation Score Allows a Better Stratification of High-Risk Patients Undergoing Reduced-Toxicity Allogeneic Hematopoietic Cell Transplantation

Pere Barba, Rodrigo Martino, José Antonio Pérez-Simón, Francesc Fernández-Avilés, Nerea Castillo, José Luis Piñana, Lucía López-Anglada, Montserrat Rovira, Francesc Bosch, Enric Carreras, Lucía López Corral, Jorge Sierra, David Valcárcel

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27 Citations (Scopus)

Abstract

This study was conducted to determine whether the integration of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score would improve individual capacity for stratification of high-risk HCT candidates. A total of 442 consecutive patients receiving an allogeneic HCT after reduced-toxicity conditioning was included. Final HCT-CI and EBMT scores were calculated and validated. Then, patients were grouped into a 6-category new combination model according to the HCT-CI (0, 1 to 2, ≥3) and EBMT scores (0 to 3, 4 to 7), and the model's predictive capacity was also evaluated. Median HCT-CI and EBMT scores were 3 and 4, respectively. Increased HCT-CI was associated with higher 4-year nonrelapse mortality (NRM) and lower 4-year overall survival (OS), whereas a high EBMT score was associated with higher 4-year NRM. The HCT-CI showed a trend for a better predictive capacity than the EBMT score (c-statistic .6 versus .54, P=1). According to the new model, patients within HCT-CI of 0 and HCT-CI of 1 to 2 groups had similar risk of NRM independently of their EBMT score. Within the HCT-CI ≥ 3 group, patients with low EBMT score showed lower NRM (25% versus 40%, P=04) and a trend to higher OS (52% versus 36%, P=06) than patients with a high EBMT score. Moreover, patients with HCT-CI ≥ 3 and EBMT score 0 to 3 had similar outcomes than those with HCT-CI of 1 to 2. In conclusion, the combination of HCT-CI and the EBMT score is feasible and might contribute to a better identification of high-risk patients, improving selection of best allogeneic HCT candidates. © 2014 American Society for Blood and Marrow Transplantation.
Original languageEnglish
Pages (from-to)66-72
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number1
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Allo-reduced-intensity conditioning
  • Comorbidity
  • EBMT score
  • HCT-CI
  • Reduced-intensity conditioning stem cell transplantation

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