TY - JOUR
T1 - Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation
AU - Sorror, Mohamed
AU - Storer, Barry
AU - Sandmaier, Brenda M.
AU - Maloney, David G.
AU - Chauncey, Thomas R.
AU - Langston, Amelia
AU - Maziarz, Richard T.
AU - Pulsipher, Michael
AU - McSweeney, Peter A.
AU - Storb, Rainer
PY - 2008/5/1
Y1 - 2008/5/1
N2 - BACKGROUND. Elderly and medically infirm cancer patients are increasingly offered allogeneic nonmyeloablative hematopoietic cell transplantation (HCT). A better understanding of the impact of health status on HCT outcomes is warranted. Herein, a recently developed HCT-specific comorbidity index (HCT-CI) was compared with a widely acceptable measure of health status, the Karnofsky performance status (KPS). METHODS. The outcomes of 341 patients were evaluated, conditioned for either related or unrelated HCT by 2-gray (Gy) total body irradiation given alone or combined with fludarabine at a dose of 90 mg/m 2. Comorbidities were assessed retrospectively by the HCT-CI. Performance status before and toxicities after HCT were graded prospectively using the KPS and National Cancer Institute Common Toxicity criteria, respectively. RESULTS. Weak Spearman rank correlations were noted between HCT-CI and KPS and between the 2 measures and age, number of prior chemotherapy regimens, and intervals between diagnosis and HCT (all r < 0.20). High-risk diseases correlated significantly with higher mean HCT-CI scores (P = .009) but not low KPS (P = .37). In multivariate models, the HCT-CI had significantly greater independent predictive power for toxicities (P = .004), nonrelapse mortality (P = .0002), and overall mortality (P = .0002) compared with the KPS (P = .05, .13, and .05, respectively). Using consolidated HCT-CI and KPS scores, patients were stratified into 4 risk groups with 2-year survivals of 68%, 58%, 41%, and 32%, respectively. CONCLUSIONS. HCT-CI and KPS should be assessed simultaneously before HCT. The use of both tools combined likely refines risk-stratification for HCT outcomes. Novel guidelines for assessment of performance status among HCT patients are warranted.
AB - BACKGROUND. Elderly and medically infirm cancer patients are increasingly offered allogeneic nonmyeloablative hematopoietic cell transplantation (HCT). A better understanding of the impact of health status on HCT outcomes is warranted. Herein, a recently developed HCT-specific comorbidity index (HCT-CI) was compared with a widely acceptable measure of health status, the Karnofsky performance status (KPS). METHODS. The outcomes of 341 patients were evaluated, conditioned for either related or unrelated HCT by 2-gray (Gy) total body irradiation given alone or combined with fludarabine at a dose of 90 mg/m 2. Comorbidities were assessed retrospectively by the HCT-CI. Performance status before and toxicities after HCT were graded prospectively using the KPS and National Cancer Institute Common Toxicity criteria, respectively. RESULTS. Weak Spearman rank correlations were noted between HCT-CI and KPS and between the 2 measures and age, number of prior chemotherapy regimens, and intervals between diagnosis and HCT (all r < 0.20). High-risk diseases correlated significantly with higher mean HCT-CI scores (P = .009) but not low KPS (P = .37). In multivariate models, the HCT-CI had significantly greater independent predictive power for toxicities (P = .004), nonrelapse mortality (P = .0002), and overall mortality (P = .0002) compared with the KPS (P = .05, .13, and .05, respectively). Using consolidated HCT-CI and KPS scores, patients were stratified into 4 risk groups with 2-year survivals of 68%, 58%, 41%, and 32%, respectively. CONCLUSIONS. HCT-CI and KPS should be assessed simultaneously before HCT. The use of both tools combined likely refines risk-stratification for HCT outcomes. Novel guidelines for assessment of performance status among HCT patients are warranted.
KW - Allogeneic hematopoietic cell transplantation
KW - Hematologic malignancies
KW - Hematopoietic cell transplantation-specific comorbidity index
KW - Karnofsky performance status
KW - Nonmyeloablative conditioning
KW - Nonrelapse mortality
KW - Post-transplantation toxicities
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U2 - 10.1002/cncr.23375
DO - 10.1002/cncr.23375
M3 - Article
C2 - 18311781
AN - SCOPUS:42449142954
SN - 0008-543X
VL - 112
SP - 1992
EP - 2001
JO - Cancer
JF - Cancer
IS - 9
ER -