Prospective Validation of the Predictive Power of the Hematopoietic Cell Transplantation Comorbidity Index: A Center for International Blood and Marrow.

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Presentation transcript:

Prospective Validation of the Predictive Power of the Hematopoietic Cell Transplantation Comorbidity Index: A Center for International Blood and Marrow Transplant Research Study Mohamed L. Sorror, Brent R. Logan, Xiaochun Zhu, J. Douglas Rizzo, Kenneth R. Cooke, Philip L. McCarthy, Vincent T. Ho, Mary M. Horowitz, Marcelo C. Pasquini Biology of Blood and Marrow Transplantation Volume 21, Issue 8, Pages 1479-1487 (August 2015) DOI: 10.1016/j.bbmt.2015.04.004 Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Organization chart of patient eligibility and enrollment into the prospective observational study. Among a total sample of 23,876 patients who received hematopoietic cell transplantation in United States between December 2007 and December 2009, 8115 recipients of allogeneic and 11,652 recipients of autologous HCT contributed to the study analyses. Biology of Blood and Marrow Transplantation 2015 21, 1479-1487DOI: (10.1016/j.bbmt.2015.04.004) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Prevalence of comorbidities as captured by the HCT-CI among recipients of high-dose allogeneic, reduced-intensity/nonmyeloablative allogeneic, and autologous HCT. Pulmonary, psychiatric, and heart comorbidities were the most prevalent among all 3 groups of patients. Biology of Blood and Marrow Transplantation 2015 21, 1479-1487DOI: (10.1016/j.bbmt.2015.04.004) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Illustration of the independent associations between HCT-CI score groups and risks of NRM and overall mortality among recipients of HCT using Cox regression models. Among recipients of allogeneic HCT, (A) HCT-CI scores of 1 and 2 and ≥3 were statistically significantly associated with increased risks for NRM and reduced overall mortality compared with a score of 0. When the HCT-CI was categorized into 0, 1, 2, 3, 4, and ≥5, for prediction of (B) NRM and (C) overall mortality among recipient of allogeneic HCT, each increased score was statistically significantly associated with higher risks for these outcomes, with the exception of the associations between scores 1 and 2 with NRM, which did not reach statistical significance. Among recipients of autologous HCT, HCT-CI score stratification of 1 and 2 and ≥3 was used for prediction of risks for NRM and overall mortality in (D). Biology of Blood and Marrow Transplantation 2015 21, 1479-1487DOI: (10.1016/j.bbmt.2015.04.004) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Stratification of probabilities of outcomes by the HCT-CI scores among recipients of allogeneic or autologous HCT. Among recipients of allogeneic HCT (A and B), HCT-CI scores of 0, 1 and 2, 3, 4, and ≥5 stratified well probabilities of (A) NRM and (B) survival. Among recipients of autologous HCT, HCT-CI scores of 0, 1 and 2, ≥3 stratified well probabilities of (C) NRM and (D) survival. Biology of Blood and Marrow Transplantation 2015 21, 1479-1487DOI: (10.1016/j.bbmt.2015.04.004) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 Subgroup validation of the predictive power of the HCT-CI among recipients of allogeneic HCT after high-dose versus reduced-intensity/nonmyeloablative conditioning regimens. (A) and (B) demonstrate results from Cox regression models focusing on NRM and overall mortality. HCT-CI scores of 1 and 2 and ≥3 were statistically significantly associated with increased risks for NRM and overall mortality among recipients of (A) high-dose conditioning regimens, whereas only scores of ≥3 were associated with the same outcomes among recipients of (B) reduced-intensity/nonmyeloablative conditioning regimens compared with those with a score of 0. (C, D, E and F) Demonstrate probabilities of TRM and survival. HCT-CI scores of 1 and 2 and ≥3 stratified well probabilities of (C) NRM and (D) overall survival among recipients of high-dose conditioning. Only patients with HCT-CI scores of ≥3 experienced (E) increased probabilities of NRM and (F) decreased probabilities of survival among recipients of reduced-intensity/nonmyeloablative conditioning regimens compared to those with a score of 0. Biology of Blood and Marrow Transplantation 2015 21, 1479-1487DOI: (10.1016/j.bbmt.2015.04.004) Copyright © 2015 American Society for Blood and Marrow Transplantation Terms and Conditions