Comorbidity-age index: A clinical measure of biologic age before allogeneic hematopoietic cell transplantation

Mohamed L. Sorror, Rainer F. Storb, Brenda M. Sandmaier, Richard T. Maziarz, Michael A. Pulsipher, Michael B. Maris, Smita Bhatia, Fabiana Ostronoff, H. Joachim Deeg, Karen L. Syrjala, Elihu Estey, David G. Maloney, Frederick R. Appelbaum, Paul J. Martin, Barry E. Storer

Research output: Contribution to journalArticle

180 Scopus citations

Abstract

Patients and Methods: Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age ntervals and a validation set to assess the performance of prognostic models.

Purpose: Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cel transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown.

Results: In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P =.29), 1.48 (P =.04), 1.75 (P =.004), and 1.84 (P =.005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P <.001) and survival (0.682 v 0.560; P <.001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens.

Conclusion: Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.

Original languageEnglish (US)
Pages (from-to)3249-3256
Number of pages8
JournalJournal of Clinical Oncology
Volume32
Issue number29
DOIs
StatePublished - Oct 10 2014

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Sorror, M. L., Storb, R. F., Sandmaier, B. M., Maziarz, R. T., Pulsipher, M. A., Maris, M. B., Bhatia, S., Ostronoff, F., Deeg, H. J., Syrjala, K. L., Estey, E., Maloney, D. G., Appelbaum, F. R., Martin, P. J., & Storer, B. E. (2014). Comorbidity-age index: A clinical measure of biologic age before allogeneic hematopoietic cell transplantation. Journal of Clinical Oncology, 32(29), 3249-3256. https://doi.org/10.1200/JCO.2013.53.8157