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Evaluation of pre-transplant risk assessments in allogeneic hematopoietic cell transplant

Bone Marrow Transplantation volume 57, pages 1031–1033 (2022)Cite this article

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Allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative therapy for high-risk hematologic malignancies. Advancements in transplant approaches and supportive care have expanded its use to more patients, including those older and less fit. Several risk assessment tools using pre-transplant factors have been developed to predict survival for patients undergoing HCT [1]. Some tools focus more on patient, disease, transplant, or psychosocial factors [2] while others incorporate multiple variables into models to provide prognostic estimates. Despite the validation of many pre-transplant risk assessments, there are limited studies evaluating the these tools’ comparative effectiveness in predicting mortality [1]. We thus sought to evaluate several risk assessments to determine their prognostic value for overall survival (OS) and non-relapse mortality (NRM) after HCT.

Pre-transplant risk scores are calculated for all patients undergoing allogeneic HCT at our institution. These include the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) [3], Psychosocial Assessment of Candidates for Transplantation (PACT) score [2], Center for International Bone Marrow Transplant Research (CIBMTR) 1-year overall survival (OS1) score [4], Pre-transplant Assessment of Mortality (PAM) score [5], and American Society of Bone Marrow Transplant (ASBMT) disease risk classification [6]. We identified 252 adult patients undergoing first allogeneic HCT between 1/2016 and 12/2019 who consented for their data to be used for research and were assigned pre-transplant risk assessment scores for inclusion in this study. Patients were stratified into “low”, “intermediate”, or “high” risk groups for four of the risk assessment tools. ASBMT disease risk classification was categorized into low, intermediate, high, and “unclassified” risk for patients with unclassified myeloproliferative neoplasms. Components and classifications as previously defined are shown in Supplementary Table 1.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available to preserve patient confidentiality, but de-identified data are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Pranay S. Hegde

  2. Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Lisa Rybicki

  3. Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Sheila Serafino, Laura Bernhard, Donna Corrigan, Faiz Anwer, Matt Kalaycio, Ronald M. Sobecks, Deepa Jagadeesh, Brian T. Hill, Robert M. Dean, Jack Khouri, Allison M. Winter, Brad Pohlman, Navneet S. Majhail & Betty K. Hamilton

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  1. Pranay S. Hegde
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  2. Lisa Rybicki
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  3. Sheila Serafino
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Contributions

PH analyzed and interpreted data and wrote the manuscript. LR provided statistical support and critically reviewed the manuscript. SS, LB, DC, FA, MK, RMS, DJ, BTH, RMD, JK, AMW, BP, and NSM contributed patient data collection and critically reviewed the manuscript. BKH designed the study, analyzed and interpreted data, and wrote and critically reviewed the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Betty K. Hamilton.

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The authors declare no competing interests.

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Hegde, P.S., Rybicki, L., Serafino, S. et al. Evaluation of pre-transplant risk assessments in allogeneic hematopoietic cell transplant. Bone Marrow Transplant 57, 1031–1033 (2022). https://doi.org/10.1038/s41409-022-01677-8

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