The predictive value of HCT-CI and CCI comorbidity indices in predicting survival and mortality before allogeneic stem cell transplantation in acute leukemia patients: A single-centre experience

Yıl 2024, , 274 - 281, 30.10.2024

Ozlem Candan , Ali Yanigün Derya Demirtas , Ahmet Mert Yanık , Meral Uluköylü Mengüç , Ceren Uzunoğlu Güren Seçil Salim Fatma Geçgel , Fergun Yilmaz , Işık Atagündüz Ayşe Tülin Tuğlular Tayfur Toptas

https://doi.org/10.5472/marumj.1571254

Öz

Objective: Acute leukemia often involves comorbidities, impacting treatment decisions and patient outcomes. Clinicians commonly
use the Charlson Comorbidity Index (CCI) and the Hematopoietic Stem Cell Transplantation Comorbidity Index (HCT-CI) to assess
their influence. However, their effectiveness in predicting survival and non-relapse mortality (NRM) in acute leukemia patients under
65 undergoing allogeneic stem cell transplantation remains unclear.
Patients and Methods: We conducted a retrospective single-center analysis on adults diagnosed with acute myeloid leukemia (AML) or
acute lymphoblastic leukemia (ALL). The study included 35 patients, comprising 16 AML and 19 ALL cases. Patients were categorized
based on age-adjusted HCT-CI and CCI scores.
Results: The 2-year NRM rate was determined to be 51.4%. Statistical analysis found no significant associations between age-adjusted
CCI (p=0.217) and age-adjusted HCT-CI (p=0.102) with NRM. However, median overall survival significantly varied based on risk
levels (p=0.003), HCT-CI groups (p=0.009), and CCI groups (p=0.011).
Conclusion: Using age-adjusted HCT-CI and CCI for comorbidity scoring in initial assessment of acute leukemia patients and those
under 65 shows promise. However, these indices were ineffective in predicting NRM, emphasizing the importance of considering
other significant pre-transplant factors like genetic risk, conditioning regimens, and donor type.

Anahtar Kelimeler

HCT-CI, CCI, Score, Allogeneic stem cell transplantation, Age adjusted, Acute leukemia

Kaynakça

• Sorror ML, Maris MB, Storer B, et al. Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplantation comorbidities. Blood 2004;104:961-8. doi: 10.1182/blood-2004-02-0545.
• Armand P, Gibson CJ, Cutler C, et al. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood 2012;120:905-13. doi: 10.1182/blood-2012-03-418202.
• Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83. doi: 10.1016/0021-9681(87)90171-8
• Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom 2022;91:8-35. doi: 10.1159/000521288
• Hall SF, Groome PA, Streiner DL, Rochon PA. Interrater reliability of measurements of comorbid illness should be reported. J Clin Epidemiol 2006;59:926-33. doi: 10.1016/j. jclinepi.2006.02.006
• De Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 2003;56:221-9. doi: 10.1016/s0895- 4356(02)00585-1
• Glasheen WP, Cordier T, Gumpina R, Haugh G, Davis J, Renda A. Charlson comorbidity index: ICD-9 update and ICD-10 translation. Am Health Drug Benefits 2019;12:188-97.
• Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005:1130-9. doi: 10.1097/01.mlr.000.018.2534.19832.83
• 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. doi: 10.1182/blood-2005-05-2004
• 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 MDACC experiences. Blood 2007;110:4606-13. doi: 10.1182/blood-2007-06-096966.
• Maruyama D, Fukuda T, Kato R, et al. Comparable antileukemia/lymphoma effects in nonremission patients undergoing allogeneic hematopoietic cell transplantation with a conventional cytoreductive or reduced-intensity regimen. Biol Blood Marrow Transplant 2007;13:932-41. doi: 10.1016/j. bbmt.2007.04.004
• 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;23:1131-8. doi: 10.1038/ leu.2009.1
• Gooley TA, Chien JW, Pergam SA, et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. N Engl J Med 2010;363:2091-101. doi: 10.1056/NEJMoa1004383
• Sorror M, Storer B, Sandmaier BM, et al. Hematopoietic cell transplantation‐comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008;112:1992-2001. doi: 10.1002/ cncr.23375
• 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. doi: 10.1200/JCO.2006.09.7865
• Sorror ML, Storer BE, Maloney DG, Sandmaier BM, Martin PJ, Storb R. Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative conditioning regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood 2008;111:446-52. doi: 10.1182/blood-2007-07-098483.
• Horan JT, Logan BR, Agovi-Johnson M-A, et al. Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made? J Clin Oncol 2011;29:805. doi: 10.1200/ JCO.2010.32.5001
• Cahn J, Labopin M, Schattenberg A, Reiffers J, Willemze R, Zittoun R, et al. Allogeneic bone marrow transplantation for acute leukemia in patients over the age of 40 years. Leukemia 1997;11:416-9. doi: 10.1038/sj.leu.2400573.
• Gomez-Nunez M, Martino R, Caballero M, et al. Elderly age and prior autologous transplantation have a deleterious effect on survival following allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning: results from the Spanish multicenter prospective trial. Bone Marrow Transplant 2004;33:477-82. doi: 10.1038/sj.bmt.1704379
• Malfuson J-V, Etienne A, Turlure P, et al. Risk factors and decision criteria for intensive chemotherapy in older patients with acute myeloid leukemia. Haematologica 2008;93:1806- 13. doi: 10.3324/haematol.13309
• Bertoli S, Bérard E, Huguet F, et al. Time from diagnosis to intensive chemotherapy initiation does not adversely impact the outcome of patients with acute myeloid leukemia. Blood 2013;121:2618-26. doi: 10.1182/blood-2012-09-454553
• Röllig C, Kramer M, Schliemann C, et al. Does time from diagnosis to treatment affect the prognosis of patients with newly diagnosed acute myeloid leukemia? Blood 2020;136:823-30. doi: 10.1182/blood.201.900.4583.
• Hamadani M, Craig M, Awan F, Devine S. How we approach patient evaluation for hematopoietic stem cell transplantation. Bone Marrow Transplant 2010;45:1259-68. doi: 10.1038/ bmt.2010.94
• Farag SS, Maharry K, Zhang M-J, et al. Comparison of reduced-intensity hematopoietic cell transplantation with chemotherapy in patients age 60-70 years with acute myelogenous leukemia in first remission. Biol Blood Marrow Transplant 2011;17:1796-803. doi: 10.1016/j. bbmt.2011.06.005. .
• Stone RM. Acute myeloid leukemia in first remission: to choose transplantation or not? J Clin Oncol 2013;31:1262-6. doi: 10.1200/JCO.2012.43.4258
• Magenau J, Couriel DR. Hematopoietic stem cell transplantation for acute myeloid leukemia: to whom, when, and how. Curr Oncol Rep 2013;15:436-44. doi: 10.1155/2022/1828223.