A modified EBMT risk score and the hematopoietic cell transplantation-specific comorbidity index for pre-transplant risk assessment in adult acute lymphoblastic leukemia

Item Type:	Article
Title:	A modified EBMT risk score and the hematopoietic cell transplantation-specific comorbidity index for pre-transplant risk assessment in adult acute lymphoblastic leukemia
Creators Name:	Terwey, T.H. and Hemmati, P.G. and Martus, P. and Dietz, E. and Vuong, L.G. and Massenkeil, G. and Doerken, B. and Arnold, R.
Abstract:	BACKGROUND: Disease stage is the most important prognostic parameter in allogeneic hematopoietic stem cell transplantation (HCT) for acute lymphoblastic leukemia (ALL), but other factors such as donor/host histocompatibility and gender combination, recipient age, performance status and comorbidities need to be considered. Several scoring systems are available to predict outcome in HCT recipients, however their prognostic relevance in ALL is not well defined. DESIGN AND METHODS: In the present study we evaluated a modified EBMT risk score (mEBMT) and the HCT-specific comorbidity index (HCT-CI) in 151 adult ALL patients who received allogeneic HCT from 1995 until 2007 at our center. RESULTS: Disease status was first complete remission (CR1) (47%), CR>1 (21%) or no CR (32%). Overall survival (OS) at 1, 2 and 5 years was 62%, 51% and 40% and non-relapse mortality (NRM) was 21%, 24% and 32%. Median mEBMT was 3 (0-6). Higher mEBMT was associated with inferior OS (hazard ratio per score unit (HR): 1.50, p<0.001), higher NRM (HR: 1.36, p=0.042) and higher relapse mortality (HR: 1.68, p<0.001). Disease stage was the predominant prognostic factor in this score. Comorbidities were present in 71% of patients with mild hepatic disease (29%), moderate pulmonary disease (28%) and infections (23%) being the most common. Median HCT-CI was 1 (0-9). In univariate analysis a trend for inferior OS (HR: 1.08, p=0.20) and higher NRM (HR: 1.14, p=0.11) with increasing HCT-CI was observed but the level of significance was not reached. In additional analyses we found that reduced Karnofsky Performance Status (KPS) was associated with inferior OS (HR: 1.34, p=0.023) and higher relapse mortality (HR: 1.71, p=0.001) when analyzed univariately, however KPS was associated with disease stage and significance was lost in multivariate analysis. CONCLUSIONS: The mEBMT was prognostic in our patient cohort with predominant influence of disease stage, whereas a trend but no significant prognostic value was observed for the HCT-CI.
Keywords:	Hematopoietic Stem Cell Transplantation, Acute Lymphoblastic Leukemia, HCT Recipients
Source:	Haematologica
ISSN:	0390-6078
Publisher:	Ferrata Storti Foundation
Volume:	95
Number:	5
Page Range:	810-818
Date:	May 2010
Official Publication:	https://doi.org/10.3324/haematol.2009.011809
PubMed:	View item in PubMed

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