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

TitleThe Simplified Comorbidity Index: a new tool for prediction of nonrelapse mortality in allo-HCT.
Publication TypeJournal Article
Year of Publication2022
AuthorsShouval R, Fein JA, Cho C, Avecilla ST, Ruiz J, Tomas AAlarcon, Sanchez-Escamilla M, Flores NCastillo, Yáñez L, Barker JN, Dahi P, Giralt SA, Geyer AI, Gyurkocza B, Jakubowski AA, Lin RJ, O'Reilly RJ, Papadopoulos EB, Politikos I, Ponce DM, Sauter CS, Scordo M, Shaffer B, Shah GL, Sullivan JP, Tamari R, van den Brink MRM, Young JW, Nagler A, Devlin S, Shimoni A, Perales M-A
JournalBlood Adv
Date Published2022 Mar 08
KeywordsAdult, Comorbidity, Hematopoietic Stem Cell Transplantation, Humans, Middle Aged, Proportional Hazards Models, Transplantation Conditioning, Transplantation, Homologous

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.

Alternate JournalBlood Adv
PubMed ID34507354
PubMed Central IDPMC8905694
Grant ListP01 CA023766 / CA / NCI NIH HHS / United States
P30 CA008748 / CA / NCI NIH HHS / United States
Related Faculty: 
Scott Avecilla, M.D., Ph.D.

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