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Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma.

Publication ,  Journal Article
Saad, A; Mahindra, A; Zhang, M-J; Zhong, X; Costa, LJ; Dispenzieri, A; Drobyski, WR; Freytes, CO; Gale, RP; Gasparetto, CJ; Holmberg, LA ...
Published in: Biol Blood Marrow Transplant
March 2014

Autologous hematopoietic stem cell transplantation (AHCT) improves survival in patients with multiple myeloma (MM) but is associated with morbidity and nonrelapse mortality (NRM). Hematopoietic cell transplant comorbidity index (HCT-CI) was shown to predict risk of NRM and survival after allogeneic transplantation. We tested the utility of HCT-CI as a predictor of NRM and survival in patients with MM undergoing AHCT. We analyzed outcomes of 1156 patients of AHCT after high-dose melphalan reported to the Center for International Blood and Marrow Transplant Research. Individual comorbidities were prospectively collected at the time of AHCT. The impact of HCT-CI and other potential prognostic factors, including Karnofsky performance score (KPS), on NRM and survival were studied in multivariate Cox regression models. HCT-CI score was 0, 1, 2, 3, and >3 in 42%, 18%, 13%, 13%, and 14% of the study cohort, respectively. Subjects were stratified into 3 risk groups: HCT-CI score of 0 (42%) versus HCT-CI score of 1 to 2 (32%) versus HCT-CI score > 2 (26%). Higher HCT-CI was associated with lower KPS < 90 (33% of subjects score of 0 versus 50% in HCT-CI score > 2). HCT-CI score > 2 was associated with melphalan dose reduction (22% versus 10% in score 0 cohort). One-year NRM was low at 2% (95% confidence interval, 1% to 4%) and did not correlate with HCT-CI score (P = .9). On multivariate analysis, overall survival was inferior in groups with HCT-CI score of 1 to 2 (relative risk, 1.37, [95% confidence interval, 1.01 to 1.87], P = .04) and HCT-CI score > 2 (relative risk, 1.5 [95% confidence interval, 1.09 to 2.08], P = .01). Overall survival was also inferior with KPS < 90 (P < .001), IgA subtype (P ≤ .001), those receiving >1 pretransplant induction regimen (P = .007), and those with resistant disease at the time of AHCT (P < .001). AHCT for MM is associated with low NRM, and death is predominantly related to disease progression. Although a higher HCT-CI score did not predict NRM, it was associated with inferior survival.

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Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

March 2014

Volume

20

Issue

3

Start / End Page

402 / 408.e1

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Transplantation Conditioning
  • Survival Analysis
  • Severity of Illness Index
  • Prognosis
  • Myeloablative Agonists
  • Multivariate Analysis
  • Multiple Myeloma
  • Middle Aged
  • Melphalan
 

Citation

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ICMJE
MLA
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Saad, A., Mahindra, A., Zhang, M.-J., Zhong, X., Costa, L. J., Dispenzieri, A., … Hari, P. N. (2014). Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant, 20(3), 402-408.e1. https://doi.org/10.1016/j.bbmt.2013.12.557
Saad, Ayman, Anuj Mahindra, Mei-Jie Zhang, Xiaobo Zhong, Luciano J. Costa, Angela Dispenzieri, William R. Drobyski, et al. “Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma.Biol Blood Marrow Transplant 20, no. 3 (March 2014): 402-408.e1. https://doi.org/10.1016/j.bbmt.2013.12.557.
Saad A, Mahindra A, Zhang M-J, Zhong X, Costa LJ, Dispenzieri A, et al. Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant. 2014 Mar;20(3):402-408.e1.
Saad, Ayman, et al. “Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma.Biol Blood Marrow Transplant, vol. 20, no. 3, Mar. 2014, pp. 402-408.e1. Pubmed, doi:10.1016/j.bbmt.2013.12.557.
Saad A, Mahindra A, Zhang M-J, Zhong X, Costa LJ, Dispenzieri A, Drobyski WR, Freytes CO, Gale RP, Gasparetto CJ, Holmberg LA, Kamble RT, Krishnan AY, Kyle RA, Marks D, Nishihori T, Pasquini MC, Ramanathan M, Lonial S, Savani BN, Saber W, Sharma M, Sorror ML, Wirk BM, Hari PN. Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant. 2014 Mar;20(3):402-408.e1.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

March 2014

Volume

20

Issue

3

Start / End Page

402 / 408.e1

Location

United States

Related Subject Headings

  • Transplantation, Autologous
  • Transplantation Conditioning
  • Survival Analysis
  • Severity of Illness Index
  • Prognosis
  • Myeloablative Agonists
  • Multivariate Analysis
  • Multiple Myeloma
  • Middle Aged
  • Melphalan