Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality

Mohamed L. Sorror, Paul J. Martin, Rainer F. Storb, Smita Bhatia, Richard Maziarz, Michael A. Pulsipher, Michael B. Maris, Christopher Davis, H. Joachim Deeg, Stephanie J. Lee, David G. Maloney, Brenda M. Sandmaier, Frederick R. Appelbaum, Theodore A. Gooley

Research output: Contribution to journalArticle

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Abstract

Whether the hematopoietic cell transplantation comorbidity index (HCT-CI) can provide prognostic information about development of acute graft-versus-host disease (GVHD) and subsequent mortality is unknown. Five institutions contributed information on 2985 patients given human leukocyte antigen-matched grafts to address this question. Proportional hazards models were used to estimate the hazards of acute GVHD and post-GVHD mortality after adjustment for known risk variables. Higher HCT-CI scores predicted increased risk of grades 3 to 4 acute GVHD (P <.0001 and c-statistic of 0.64), and tests of interaction suggested that this association was consistent among different conditioning intensities, donor types, and stem cell sources. Probabilities of grades 3 to 4 GVHD were 13%, 18%, and 24% for HCT-CI risk groups of 0, 1 to 4, and ≥5. The HCT-CI was statistically significantly associated with mortality rates following diagnosis of grade 2 (hazard ratio [HR] = 1.24; P <.0001) or grades 3 to 4 acute GVHD (HR = 1.19; P <.0001). Patients with HCT-CI scores of ≥3 who developed grades 3 to 4 acute GVHD had a 2.63-fold higher risk of mortality than those with scores of 0 to 2 and did not develop acute GVHD. Thus, pretransplant comorbidities are associated with the development and severity of acute GVHD and with post-GVHD mortality. The HCT-CI could be useful in designing trials for GVHD prevention and could inform expectations for GVHD treatment trials.

Original languageEnglish (US)
Pages (from-to)287-295
Number of pages9
JournalBlood
Volume124
Issue number2
DOIs
StatePublished - Jul 10 2014

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Graft vs Host Disease
Grafts
Comorbidity
Mortality
Cell Transplantation
Hazards
Risk Adjustment
HLA Antigens
Proportional Hazards Models
Stem cells
Stem Cells
Tissue Donors
Statistics
Transplants

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Sorror, M. L., Martin, P. J., Storb, R. F., Bhatia, S., Maziarz, R., Pulsipher, M. A., ... Gooley, T. A. (2014). Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality. Blood, 124(2), 287-295. https://doi.org/10.1182/blood-2014-01-550566

Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality. / Sorror, Mohamed L.; Martin, Paul J.; Storb, Rainer F.; Bhatia, Smita; Maziarz, Richard; Pulsipher, Michael A.; Maris, Michael B.; Davis, Christopher; Deeg, H. Joachim; Lee, Stephanie J.; Maloney, David G.; Sandmaier, Brenda M.; Appelbaum, Frederick R.; Gooley, Theodore A.

In: Blood, Vol. 124, No. 2, 10.07.2014, p. 287-295.

Research output: Contribution to journalArticle

Sorror, ML, Martin, PJ, Storb, RF, Bhatia, S, Maziarz, R, Pulsipher, MA, Maris, MB, Davis, C, Deeg, HJ, Lee, SJ, Maloney, DG, Sandmaier, BM, Appelbaum, FR & Gooley, TA 2014, 'Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality', Blood, vol. 124, no. 2, pp. 287-295. https://doi.org/10.1182/blood-2014-01-550566
Sorror, Mohamed L. ; Martin, Paul J. ; Storb, Rainer F. ; Bhatia, Smita ; Maziarz, Richard ; Pulsipher, Michael A. ; Maris, Michael B. ; Davis, Christopher ; Deeg, H. Joachim ; Lee, Stephanie J. ; Maloney, David G. ; Sandmaier, Brenda M. ; Appelbaum, Frederick R. ; Gooley, Theodore A. / Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality. In: Blood. 2014 ; Vol. 124, No. 2. pp. 287-295.
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abstract = "Whether the hematopoietic cell transplantation comorbidity index (HCT-CI) can provide prognostic information about development of acute graft-versus-host disease (GVHD) and subsequent mortality is unknown. Five institutions contributed information on 2985 patients given human leukocyte antigen-matched grafts to address this question. Proportional hazards models were used to estimate the hazards of acute GVHD and post-GVHD mortality after adjustment for known risk variables. Higher HCT-CI scores predicted increased risk of grades 3 to 4 acute GVHD (P <.0001 and c-statistic of 0.64), and tests of interaction suggested that this association was consistent among different conditioning intensities, donor types, and stem cell sources. Probabilities of grades 3 to 4 GVHD were 13{\%}, 18{\%}, and 24{\%} for HCT-CI risk groups of 0, 1 to 4, and ≥5. The HCT-CI was statistically significantly associated with mortality rates following diagnosis of grade 2 (hazard ratio [HR] = 1.24; P <.0001) or grades 3 to 4 acute GVHD (HR = 1.19; P <.0001). Patients with HCT-CI scores of ≥3 who developed grades 3 to 4 acute GVHD had a 2.63-fold higher risk of mortality than those with scores of 0 to 2 and did not develop acute GVHD. Thus, pretransplant comorbidities are associated with the development and severity of acute GVHD and with post-GVHD mortality. The HCT-CI could be useful in designing trials for GVHD prevention and could inform expectations for GVHD treatment trials.",
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AU - Pulsipher, Michael A.

AU - Maris, Michael B.

AU - Davis, Christopher

AU - Deeg, H. Joachim

AU - Lee, Stephanie J.

AU - Maloney, David G.

AU - Sandmaier, Brenda M.

AU - Appelbaum, Frederick R.

AU - Gooley, Theodore A.

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