Otolog Hematopoetik Kök Hücre Nakli Yapılan Hastalarda Komorbidite İndekslerinin Sağkalım İle İlişkisinin Değerlendirilmesi

Year 2021, Volume: 43 Issue: 4, 349 - 357, 18.05.2021

Fatih Yaman Vildan Ozkocaman Fahir Özkalemkaş Sedat Çelikçi

https://doi.org/10.20515/otd.861236

Abstract

Bu çalışmanın amacı hematopoetik kök hücre nakli yapılan hastalarda komorbidite indekslerinin sağkalımı öngörmede prediktif değerlerini saptamaktı. Ağustos 2009–Mart 2014 tarihleri arasında otolog hematopoetik kök hücre nakli (OHKHN) yapılan hematolojik maligniteli 110 hastanın verileri retrospektif olarak incelendi. Komorbidite indeksleri ve sağkalım süreleri arasındaki ilişki Kaplan-Meier testi kullanılarak incelendi. OHKHN yapılan 110 hastanın 58’ini (%53) kadın, 52’sini (%47) erkek hastalar oluşturmaktaydı. Hastaların ortanca yaşı 54 (22-72)’tü. OHKHN yapılan hastaların 84’ü (%76) Multipl miyelom (MM), 18’i (%17) Non-hodgkin lenfoma (NHL), 8’i (%7) Hodgkin lenfoma (HL) tanılıydı. 2 yıllık takiplerinde hastaların 57’si (%52) nüks olmuştu, 53’ü (%48) remisyondaydı, 40’ı (%36) hayatını kaybetmişti. Hayatta olan 70 (%64) hasta vardı. En sık komorbiditeler pulmoner hastalıklar (%33), psikiyatrik hastalıklar (%29) ve enfeksiyon hastalıklarıydı (%20). Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Flexible Hematopoietic Cell Transplantation Comorbidity Index (Flexible HCT-CI) ve Charlson Comorbidity Index (CCI) skoru ile progresyonsuz sağkalım ve genel sağkalım arasındaki ilişki incelendiğinde istatistiksel anlamlı bir ilişki bulunamadı (p>0.05). Yapılan çalışmalarda genel sağkalımı en iyi öngören komorbidite skoru HCT-CI olmakla birlikte bizim çalışmamızda daha sık 65 yaş altı, perfomans durumu iyi olan, komorbid hastalığı az olan hastalara nakil yapılması nedeni ile HCT-CI komorbidite skorunun bu grup hastalarda kullanımı ve sağkalımı öngörmedeki etkisi kısıtlıdır. Komorbidite indekslerindeki parametre sayıları arttıkça sağkalımı öngörmedeki duyarlılıkları artmaktadır. Nakil öncesi rutin kullanıma girmeleriyle birlikte bu konuyla ilgili tecrübelerimiz artacaktır.

Keywords

hematopoetik kök hücre nakli, komorbidite indeksleri, genel sağkalım, progresyonsuz sağkalım

Evaluation of the Relationship Between Comorbidity İndices and Survival in Autologous Hematopoietic Stem Cell Transplant Patients

Abstract

The aim of this study was to determine the predictive value of comorbidity indexes for survival in hematopoietic stem cell transplant patients. Data of 110 hematologic malignant patients who underwent autologous hematopoietic stem cell transplantation (OHKHN) between August 2009 and March 2014 were retrospectively reviewed. Comorbidity indexes and survival times were analyzed using the associated Kaplan-Meier test. Of the 110 patients who underwent OHKHN, 58 (53%) were female and 52 (47%) were male patients. The median age of the patients was 54 years. Multiple myeloma (MM), 18 (17%) Non-hodgkin's lymphoma (NHL) and 8 (7%) Hodgkin's lymphoma (HL) were found in 84 patients (76%). In 2 years follow-up of 110 patients with autologous transplantation, 57 (52%) had recurrences. 53 patients (48%) were in remission. Patients had lost 40 (36%) of their lives for 2 years. There were 70 (64%) patients in life. There was no statistically significant relationship between the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Flexible Hematopoietic Cell Transplantation Comorbidity Index (Flexible HCT-CI) and Charlson Comorbidity Index (CCI) scores and disease free survival and total survival (p> 0.05). Although HCT-CI is the best predictor of overall survival in studies, the use of the HCT-CI comorbidity score in this group of patients and its effect in predicting survival is limited in our study because of transplantation to patients under 65 years of age, with good performance and low comorbid disease. As the number of parameters in the comorbidity indices increases, their sensitivity in predicting survival increases. Our experience on this subject will increase as they enter into routine use before transplantation.

Keywords

hematopoietic stem cell transplantation, comorbidity indices, overall survival, progression free survival

References

• 1. Gluckman E, Rocha V, Boyer-Chammard A, et al. Outcome of cord-blood transplantation from related and unrelated donors. N Engl J Med 1997;337:373-81.
• 2. Gluckman E, Gratwohl A, Apperley J. Hematopoietic stem cell transplantation for primary amyloidosis in adult. The EBMT Handbook 2008;424-30.
• 3. Graze PR, Gale RP. Autotransplantation for leukemia and solid tumors. Transplant Proc. 1978;10:177-84.
• 4. Gürman G, Kahveci G, Akan HI, et al. Allogeneic Peripheral Blood Stem Cell Transplantation as A Second Transplant For Severe Aplastic Anemia. Bone Marrow Transplant 1995;15:4850-6.
• 5. Parimon T, Au DH, Martin PJ, Chien JW. A risk score for mortality after allogeneic hematopoietic cell transplantation. Annals of Internal Medicine, 2006;144:407-14.
• 6. Sorror ML. Comorbidities and hematopoetic cell transplantation outcomes ASH Education Book 2010;1:237-47.
• 7. Sorror ML, Maris MB, Storb R, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005;106:2912-9.
• 8. Marks DI, Cullis JO, Ward KN, et al. Allogeneic bone marrow transplantation for chronic myeloid leukemia using siblings and volunteer unrelated donors. A comparison in complication in the first 2 years. Ann Intern Med 1993;119:204-14.
• 9. Sorror ML, Storb R, Sandmaier BM, et al. Comorbidity-age index: a clinical measure of biological age prior to allogeneic hematopoietic cell transplantation. J Clin Oncol. 2014;32:3249-56.
• 10. Barba P, Piñana JL, Martino R, et al. Comparison of two pretransplant predictive models and a flexible HCT-CI using different cut points to determine low-, intermediate-, and high- risk groups: the flexible HCT-CI is the best predictor of NRM and OS in a population of patients undergoing allo-RIC. Biol Blood Marrow Transplant 2010;16:413-20.
• 11. Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson Comorbidity Index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc 2014;62:342-6.
• 12. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ. Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol 2005;23:6596-606.
• 13. Socié G, Salooja N, Cohen A, et al. Nonmalignant late effects after allogeneic stem cell transplantation. Blood 2003;101:3373-85.
• 14. Bhatia S, Ramsay NK, Steinbuch M, et al. Malignant neoplasms following bone marrow transplantation. Blood 1996;87:3633-9.
• 15. Sorror ML, Giralt S, Sandmaier BM, et al. Hematopoietic Cell Transplantation Specific Comorbidity Index As An Outcome Predictor for Patients With Acute Myeloid Leukemia in First Remission: Combined FHCRC and MCACC Experiences. Blood 2007;110:4606-13.
• 16. Charlson ME, Pompei P, Ales, KL, MacKenzie CR. A New method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases 1987;40: 373–83.
• 17. Birninger N, Bornhauser M, Schaich M, et al. The hematopoietic cell transplantation comorbidity index fails to predict outcomes in high risk AML patients undergoing allogeneic transplantation investigation of potential limitations of the index. Biol of Blood and Marrow Transplantation 2011;17:1822-32.
• 18. Kleber M, Ihorst G, Terhorst M, et al. Comorbidity as a prognostic variable in multiple myeloma: comparative evaluationof common comorbidity scores and use of a novel MM–comorbidity score. Blood Cancer Journal 2011;1:35-8.
• 19. Saad A, Mahindra A, Zhang MJ, et al. Hematopoietic Cell Transplant Comorbidity Index Is Predictive of Survival after Autologous Hematopoietic Cell Transplantation in Multiple Myeloma. Biology of Blood and Marrow Transplantation 2014;20:402-8.
• 20. Sorror ML, Sandmaier BM, Storer BE, et al. Comorbidity and disease status-based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 2007;25:4246-54.
• 21. Majhail NS, Brunstein CG, McAvoy S, et al. Does the Hematopoietic Cell Transplantation Specific Comorbidity Index Predict Transplant Outcomes? A Validation Study in a Large Cohort of Umbilical Cord Blood and Matched Related Donor Transplants. Biology of blood and marrow transplantation. 2008;9:985–92.
• 22. Guilfoyle R, Demers A, Bredeson C, et al. Performance status, but not the Hematopoietic Cell Transplantation Comorbidity Index(HCT-CI), predicts mortality at a Canadian transplant center. Bone Marrow Transplantation 2009;43:133–9.
• 23. Farina L, Bruno B, Patriarca F, et al. The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced- intensity or non-myeloablative allogeneic stem cell transplantation. Leukemia 2009;23:1131-38.
• 24. DeFor TE, Majhail NS, Weisdorf DJ, Brunstein CG. A modified comorbidity index for hematopoietic cell transplantation. Bone Marrow Transplantation 2010;45:933–8.
• 25. Terwey TH, Hemmati PG, Martus P, et al. A Modified EBMT Risk Score And The Hematopoietic Cell Transplantation-Specific Comorbidity Index For Pre-Transplant Risk Assessment In Adult Acute Lymphoblastic Leukemia. Haematologica 2010;95: 810-8.
• 26. Kataoka K, Nannya Y, Ueda K, et al. Differential prognostic impact of pretransplant comorbidity on transplant outcomes by disease status and time from transplant: a single Japanese transplant centre study. Bone Marrow Transplantation 2010;45:513–20.
• 27. Castagna L, Fürst S, Marchetti N, et al. Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intencity conditioning regimen and alloSCT. Bone Marrow Transplant 2011;46:1000-5.
• 28. Patel P, Sweiss K, Nimmagadda S, et al. Comorbidity index does not predict outcome in allogeneic myeloablative transplants conditioned with fludarabine/i.v. busulfan (FluBu4). Bone Marrow Transplantation 2011;46:1326–30.
• 29. Smith A,Majhail NS, MacMillan ML, et al. Hematopoietic cell transplantation comorbidity index predicts transplant outcomes in pediatric patients. Blood 2011;117:2728-34.
• 30. Raimondi R, Tosetto A, Oneto R, et al. Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index: a prospective, multicenter GITMO Study. Blood 2012;120:1327-33.
• 31. Nakaya A, Mori T, Tanaka M, et al. Does the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) Predict Transplantation Outcomes? A Prospective Multicenter Validation Study of the Kanto Study Group for Cell Therapy. Biology of blood and marrow transplantation. 2014;10:1553–59.