TY - JOUR
T1 - Impact of a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), on allogeneic transplant outcomes in patients with acute myeloid leukemia and myelodysplastic syndrome
AU - Kongtim, Piyanuch
AU - Parmar, Simrit
AU - Milton, Denái R.
AU - Perez, Jorge Miguel Ramos
AU - Rondon, Gabriela
AU - Chen, Julianne
AU - Chilkulwar, Abhishek R.
AU - Al-Atrash, Gheath
AU - Alousi, Amin
AU - Andersson, Borje S.
AU - Im, Jin S.
AU - Hosing, Chitra M.
AU - Bashir, Qaiser
AU - Khouri, Issa
AU - Kebriaei, Partow
AU - Oran, Betul
AU - Popat, Uday
AU - Champlin, Richard
AU - Ciurea, Stefan O.
N1 - Publisher Copyright:
© 2018, Springer Nature Limited.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Outcomes after allogeneic stem-cell transplantation (AHSCT) are influenced by both disease- and patient-related factors. Here, we developed a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), by combining the refined disease risk index (DRI-R) and hematopoietic stem-cell transplant comorbidity/age index (HCT-CI/Age) to predict post-transplant survival for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). The analysis included 942 AML/MDS patients treated with AHSCT. Patients were stratified into 4 HCT-CR risk groups: Low-risk—patients with low/intermediate DRI-R and HCT-CI/Age ≤3 (N = 272); Intermediate-risk—patients with low/intermediate DRI-R and HCT-CI/Age >3 (N = 168); High-risk—patients with high/very high DRI-R and HCT-CI/Age ≤3 (N = 284); and Very high-risk—patients with high/very high DRI-R and HCT-CI/Age >3 (N = 184). Compared with the low-risk group, intermediate, high, and very high-risk groups had a significantly increased risk of death [adjusted HR of 1.37 (P < 0.04), 2.08 (P < 0.001), and 2.92 (P < 0.001), respectively]. The concordance test showed that the HCT-CR model provided better discriminative capacity for OS prediction compared with all prior models independently, including cytogenetic risk group, DRI-R, and HCT-CI/Age model (C-indices: 0.62, 0.55, 0.60, and 0.54, respectively) (P < 0.001). In conclusion, combining disease- and patient-related factors provides better survival stratification for patients with AML/MDS receiving AHSCT.
AB - Outcomes after allogeneic stem-cell transplantation (AHSCT) are influenced by both disease- and patient-related factors. Here, we developed a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), by combining the refined disease risk index (DRI-R) and hematopoietic stem-cell transplant comorbidity/age index (HCT-CI/Age) to predict post-transplant survival for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). The analysis included 942 AML/MDS patients treated with AHSCT. Patients were stratified into 4 HCT-CR risk groups: Low-risk—patients with low/intermediate DRI-R and HCT-CI/Age ≤3 (N = 272); Intermediate-risk—patients with low/intermediate DRI-R and HCT-CI/Age >3 (N = 168); High-risk—patients with high/very high DRI-R and HCT-CI/Age ≤3 (N = 284); and Very high-risk—patients with high/very high DRI-R and HCT-CI/Age >3 (N = 184). Compared with the low-risk group, intermediate, high, and very high-risk groups had a significantly increased risk of death [adjusted HR of 1.37 (P < 0.04), 2.08 (P < 0.001), and 2.92 (P < 0.001), respectively]. The concordance test showed that the HCT-CR model provided better discriminative capacity for OS prediction compared with all prior models independently, including cytogenetic risk group, DRI-R, and HCT-CI/Age model (C-indices: 0.62, 0.55, 0.60, and 0.54, respectively) (P < 0.001). In conclusion, combining disease- and patient-related factors provides better survival stratification for patients with AML/MDS receiving AHSCT.
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UR - http://www.scopus.com/inward/citedby.url?scp=85054001831&partnerID=8YFLogxK
U2 - 10.1038/s41409-018-0344-9
DO - 10.1038/s41409-018-0344-9
M3 - Article
C2 - 30258129
AN - SCOPUS:85054001831
SN - 0268-3369
VL - 54
SP - 839
EP - 848
JO - Bone marrow transplantation
JF - Bone marrow transplantation
IS - 6
ER -