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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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