Proposed Comorbidity-Age Index in Prognostic Model for Allogeneic Hematopoietic Cell Transplantation
In a study reported in the Journal of Clinical Oncology, Sorror et al found that a composite comorbidity-age index was better than age alone in predicting nonrelapse mortality and survival in patients undergoing allogeneic hematopoietic cell transplantation.
Study Details
The study included data from 3,033 consecutive recipients of HLA-matched grafts from five U.S. institutions. In a training set, compared with patients aged < 20 years, hazard ratios (HRs) for nonrelapse mortality were 1.21 (P = .29), 1.48 (P = .04), 1.75 (P = .004), and 1.84 (P = .005) in patients aged 20 to 39, 40 to 49, 50 to 59, and ≥ 60 years, respectively.
Composite Index
In the validation set, age ≥ 40 years was given a weight of 1 and added to the hematopoietic cell transplantation comorbidity index. The composite index had significantly higher c-statistic estimates for predicting nonrelapse mortality (0.664 vs 0.556, P < .001) and overall survival (0.682 vs 0.560, P < .001) compared with age alone.
The c-statistic estimates using the composite index did not differ significantly from those using the hematopoietic cell transplantation comorbidity index alone (0.675, P = .56, and 0.649, P = .28). The improvements in c-statistic estimates for nonrelapse mortality with the composite index vs age were consistent across use of high-dose (0.681 vs 0.568), reduced-intensity (0.641 vs 0.548), and nonmyeloablative conditioning regimens (0.653 vs 0.531).
Patients with low comorbidity-age scores (0-2) had comparable mortality risks regardless of conditioning regimens. Patients with higher scores (3–4 and ≥ 5) had significantly higher mortality risk after high-dose vs nonmyeloablative regimens (HR = 0.72, P = .004) but not vs reduced-intensity regimens (HR = 0.99, P = .95).
The investigators concluded: “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 [hematopoietic cell transplantation].”
Mohamed L. Sorror, MD, of the Fred Hutchinson Cancer Research Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the National Institutes of Health, American Cancer Society, and Patient-Centered Outcome Research Institute.
The authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
