Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy

Aya Nakaya, Takehiko Mori, Masatsugu Tanaka, Naoto Tomita, Chiaki Nakaseko, Shingo Yano, Shin Fujisawa, Hisashi Sakamaki, Nobuyuki Aotsuka, Akira Yokota, Yoshinobu Kanda, Toru Sakura, Yasuhito Nanya, Takayuki Saitoh, Heiwa Kanamori, Satoshi Takahashi, Shinichiro Okamoto

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Recent advances in allogeneic hematopoietic stem cell transplantation have led to increasing use of this modality in older patients who tend to have been more heavily pretreated and have more comorbidities. Thus, the evaluation of comorbidity is of increasing importance to more precisely assess the benefits and risks of the transplantation procedure. Researchers from Seattle developed the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), which was associated with the risk of mortality in several retrospective studies. However, its clinical utility has not been extensively documented in prospective studies. The aim of the present study was to evaluate the utility of the HCT-CI prospectively in a multicenter setting. Overall survival (OS) and nonrelapse mortality (NRM) at 2years were 59% and 20%, respectively (n=243). We found that the HCT-CI in its original scale failed to predict OS and NRM in this set of patients. Thus, we applied a flexible HCT-CI risk scoring system (restratifying scores from 0 to 3 to indicate low risk, and scores of 4 or higher as high-risk). The flexible HCT-CI was found to predict 2-year NRM and OS better than the original HCT-CI (NRM: P=01, OS: P=003). In subgroup analysis, we evaluated the usefulness of the original HCT-CI for patients excluding those who received cord blood transplantation (n=186). Both 2-year OS and 2-year NRM were not significantly different according to the original HCT-CI (P=304, P=996), but with the flexible HCT-CI, there were significant differences in 2-year OS and 2-year NRM (P=005 and P=005, respectively). Multivariate analysis identified age >50, performance status (PS) <90, donor type (HLA-mismatched/unrelated donor), and the flexible HCT-CI ≥4 as significant predictors for worse OS at 2years. However, the flexible HCT-CI did not remain a significant predictor for NRM at 2years in multivariate analysis, whereas age, PS, and donor type did. The HCT-CI did not consistently predict both NRM and OS, but it still can be a useful tool in combination with other factors, such as PS and age. Furthermore, the HCT-CI, although potentially useful for capturing pretransplantation comorbidity and risk assessment, may need further validation before its adoption for routine clinical use.

Original languageEnglish
Pages (from-to)1553-1559
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number10
DOIs
Publication statusPublished - 2014 Oct 1

Fingerprint

Validation Studies
Cell Transplantation
Group Psychotherapy
Cell- and Tissue-Based Therapy
Multicenter Studies
Comorbidity
Transplantation
Mortality
Survival
Multivariate Analysis
Tissue Donors
Unrelated Donors
Hematopoietic Stem Cell Transplantation
Fetal Blood

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Flexible hematopoietic cell transplantation-specific comorbidity index
  • Prospective study

ASJC Scopus subject areas

  • Transplantation
  • Hematology
  • Medicine(all)

Cite this

Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy. / Nakaya, Aya; Mori, Takehiko; Tanaka, Masatsugu; Tomita, Naoto; Nakaseko, Chiaki; Yano, Shingo; Fujisawa, Shin; Sakamaki, Hisashi; Aotsuka, Nobuyuki; Yokota, Akira; Kanda, Yoshinobu; Sakura, Toru; Nanya, Yasuhito; Saitoh, Takayuki; Kanamori, Heiwa; Takahashi, Satoshi; Okamoto, Shinichiro.

In: Biology of Blood and Marrow Transplantation, Vol. 20, No. 10, 01.10.2014, p. 1553-1559.

Research output: Contribution to journalArticle

Nakaya, A, Mori, T, Tanaka, M, Tomita, N, Nakaseko, C, Yano, S, Fujisawa, S, Sakamaki, H, Aotsuka, N, Yokota, A, Kanda, Y, Sakura, T, Nanya, Y, Saitoh, T, Kanamori, H, Takahashi, S & Okamoto, S 2014, 'Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy', Biology of Blood and Marrow Transplantation, vol. 20, no. 10, pp. 1553-1559. https://doi.org/10.1016/j.bbmt.2014.06.005
Nakaya, Aya ; Mori, Takehiko ; Tanaka, Masatsugu ; Tomita, Naoto ; Nakaseko, Chiaki ; Yano, Shingo ; Fujisawa, Shin ; Sakamaki, Hisashi ; Aotsuka, Nobuyuki ; Yokota, Akira ; Kanda, Yoshinobu ; Sakura, Toru ; Nanya, Yasuhito ; Saitoh, Takayuki ; Kanamori, Heiwa ; Takahashi, Satoshi ; Okamoto, Shinichiro. / Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy. In: Biology of Blood and Marrow Transplantation. 2014 ; Vol. 20, No. 10. pp. 1553-1559.
@article{6603bffc7624479ebf4380fa23262ce1,
title = "Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy",
abstract = "Recent advances in allogeneic hematopoietic stem cell transplantation have led to increasing use of this modality in older patients who tend to have been more heavily pretreated and have more comorbidities. Thus, the evaluation of comorbidity is of increasing importance to more precisely assess the benefits and risks of the transplantation procedure. Researchers from Seattle developed the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), which was associated with the risk of mortality in several retrospective studies. However, its clinical utility has not been extensively documented in prospective studies. The aim of the present study was to evaluate the utility of the HCT-CI prospectively in a multicenter setting. Overall survival (OS) and nonrelapse mortality (NRM) at 2years were 59{\%} and 20{\%}, respectively (n=243). We found that the HCT-CI in its original scale failed to predict OS and NRM in this set of patients. Thus, we applied a flexible HCT-CI risk scoring system (restratifying scores from 0 to 3 to indicate low risk, and scores of 4 or higher as high-risk). The flexible HCT-CI was found to predict 2-year NRM and OS better than the original HCT-CI (NRM: P=01, OS: P=003). In subgroup analysis, we evaluated the usefulness of the original HCT-CI for patients excluding those who received cord blood transplantation (n=186). Both 2-year OS and 2-year NRM were not significantly different according to the original HCT-CI (P=304, P=996), but with the flexible HCT-CI, there were significant differences in 2-year OS and 2-year NRM (P=005 and P=005, respectively). Multivariate analysis identified age >50, performance status (PS) <90, donor type (HLA-mismatched/unrelated donor), and the flexible HCT-CI ≥4 as significant predictors for worse OS at 2years. However, the flexible HCT-CI did not remain a significant predictor for NRM at 2years in multivariate analysis, whereas age, PS, and donor type did. The HCT-CI did not consistently predict both NRM and OS, but it still can be a useful tool in combination with other factors, such as PS and age. Furthermore, the HCT-CI, although potentially useful for capturing pretransplantation comorbidity and risk assessment, may need further validation before its adoption for routine clinical use.",
keywords = "Allogeneic hematopoietic stem cell transplantation, Flexible hematopoietic cell transplantation-specific comorbidity index, Prospective study",
author = "Aya Nakaya and Takehiko Mori and Masatsugu Tanaka and Naoto Tomita and Chiaki Nakaseko and Shingo Yano and Shin Fujisawa and Hisashi Sakamaki and Nobuyuki Aotsuka and Akira Yokota and Yoshinobu Kanda and Toru Sakura and Yasuhito Nanya and Takayuki Saitoh and Heiwa Kanamori and Satoshi Takahashi and Shinichiro Okamoto",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.bbmt.2014.06.005",
language = "English",
volume = "20",
pages = "1553--1559",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "10",

}

TY - JOUR

T1 - Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A Prospective multicenter validation study of the kanto study group for cell therapy

AU - Nakaya, Aya

AU - Mori, Takehiko

AU - Tanaka, Masatsugu

AU - Tomita, Naoto

AU - Nakaseko, Chiaki

AU - Yano, Shingo

AU - Fujisawa, Shin

AU - Sakamaki, Hisashi

AU - Aotsuka, Nobuyuki

AU - Yokota, Akira

AU - Kanda, Yoshinobu

AU - Sakura, Toru

AU - Nanya, Yasuhito

AU - Saitoh, Takayuki

AU - Kanamori, Heiwa

AU - Takahashi, Satoshi

AU - Okamoto, Shinichiro

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Recent advances in allogeneic hematopoietic stem cell transplantation have led to increasing use of this modality in older patients who tend to have been more heavily pretreated and have more comorbidities. Thus, the evaluation of comorbidity is of increasing importance to more precisely assess the benefits and risks of the transplantation procedure. Researchers from Seattle developed the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), which was associated with the risk of mortality in several retrospective studies. However, its clinical utility has not been extensively documented in prospective studies. The aim of the present study was to evaluate the utility of the HCT-CI prospectively in a multicenter setting. Overall survival (OS) and nonrelapse mortality (NRM) at 2years were 59% and 20%, respectively (n=243). We found that the HCT-CI in its original scale failed to predict OS and NRM in this set of patients. Thus, we applied a flexible HCT-CI risk scoring system (restratifying scores from 0 to 3 to indicate low risk, and scores of 4 or higher as high-risk). The flexible HCT-CI was found to predict 2-year NRM and OS better than the original HCT-CI (NRM: P=01, OS: P=003). In subgroup analysis, we evaluated the usefulness of the original HCT-CI for patients excluding those who received cord blood transplantation (n=186). Both 2-year OS and 2-year NRM were not significantly different according to the original HCT-CI (P=304, P=996), but with the flexible HCT-CI, there were significant differences in 2-year OS and 2-year NRM (P=005 and P=005, respectively). Multivariate analysis identified age >50, performance status (PS) <90, donor type (HLA-mismatched/unrelated donor), and the flexible HCT-CI ≥4 as significant predictors for worse OS at 2years. However, the flexible HCT-CI did not remain a significant predictor for NRM at 2years in multivariate analysis, whereas age, PS, and donor type did. The HCT-CI did not consistently predict both NRM and OS, but it still can be a useful tool in combination with other factors, such as PS and age. Furthermore, the HCT-CI, although potentially useful for capturing pretransplantation comorbidity and risk assessment, may need further validation before its adoption for routine clinical use.

AB - Recent advances in allogeneic hematopoietic stem cell transplantation have led to increasing use of this modality in older patients who tend to have been more heavily pretreated and have more comorbidities. Thus, the evaluation of comorbidity is of increasing importance to more precisely assess the benefits and risks of the transplantation procedure. Researchers from Seattle developed the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), which was associated with the risk of mortality in several retrospective studies. However, its clinical utility has not been extensively documented in prospective studies. The aim of the present study was to evaluate the utility of the HCT-CI prospectively in a multicenter setting. Overall survival (OS) and nonrelapse mortality (NRM) at 2years were 59% and 20%, respectively (n=243). We found that the HCT-CI in its original scale failed to predict OS and NRM in this set of patients. Thus, we applied a flexible HCT-CI risk scoring system (restratifying scores from 0 to 3 to indicate low risk, and scores of 4 or higher as high-risk). The flexible HCT-CI was found to predict 2-year NRM and OS better than the original HCT-CI (NRM: P=01, OS: P=003). In subgroup analysis, we evaluated the usefulness of the original HCT-CI for patients excluding those who received cord blood transplantation (n=186). Both 2-year OS and 2-year NRM were not significantly different according to the original HCT-CI (P=304, P=996), but with the flexible HCT-CI, there were significant differences in 2-year OS and 2-year NRM (P=005 and P=005, respectively). Multivariate analysis identified age >50, performance status (PS) <90, donor type (HLA-mismatched/unrelated donor), and the flexible HCT-CI ≥4 as significant predictors for worse OS at 2years. However, the flexible HCT-CI did not remain a significant predictor for NRM at 2years in multivariate analysis, whereas age, PS, and donor type did. The HCT-CI did not consistently predict both NRM and OS, but it still can be a useful tool in combination with other factors, such as PS and age. Furthermore, the HCT-CI, although potentially useful for capturing pretransplantation comorbidity and risk assessment, may need further validation before its adoption for routine clinical use.

KW - Allogeneic hematopoietic stem cell transplantation

KW - Flexible hematopoietic cell transplantation-specific comorbidity index

KW - Prospective study

UR - http://www.scopus.com/inward/record.url?scp=84912521796&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84912521796&partnerID=8YFLogxK

U2 - 10.1016/j.bbmt.2014.06.005

DO - 10.1016/j.bbmt.2014.06.005

M3 - Article

VL - 20

SP - 1553

EP - 1559

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 10

ER -