Impact of comorbidities constituting the hematopoietic cell transplant (HCT)‐comorbidity index on the outcome of patients undergoing allogeneic HCT for acute myeloid leukemia

• Published in: European journal of haematology Vol. 100; no. 2; pp. 198 - 205
• Main Authors: Khalil, Manar M. I., Lipton, Jeffrey H., Atenafu, Eshetu G., Gupta, Vikas, Kim, Dennis D., Kuruvilla, John, Viswabandya, Auro, Messner, Hans A., Michelis, Fotios V.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2018
• Subjects: Acute myeloid leukemia; allogeneic hematopoietic cell transplant; Comorbidity; Diabetes; Diabetes mellitus; hematopoietic cell transplant comorbidity index; Leukemia; Myeloid leukemia; Studies; allogeneic hematopoietic cell transplant; hematopoietic cell transplant comorbidity index; comorbidity; acute myeloid leukemia
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.13000

Objective
To investigate the prognostic impact of the individual component comorbidities of the hematopoietic cell transplant comorbidity index (HCT‐CI) in patients with acute myeloid leukemia (AML) that underwent allogeneic hematopoietic cell transplant (HCT).
Method
This single‐center study retrospectively investigated the individual comorbidities of the HCT‐CI on the outcome of 418 patients that underwent HCT for AML, in CR1 (n = 303, 72%) or CR2 (n = 115, 28%) at our center between 1999 and 2014.
Results
Median age at HCT was 50 years (range 18‐71). Univariate analysis of the HCT‐CI, grouped as score 0 (n = 109), 1‐2 (n = 157) and ≥3 (n = 152), demonstrated significant influence on overall survival (OS) (P = .004) and non‐relapse mortality (NRM) (P = .02). For individual comorbidities constituting the HCT‐CI, variables with a P‐value ≤ .2 on univariate analysis were included in the multivariable analysis. For OS, none of the comorbidities of the HCT‐CI demonstrated independent prognostic relevance. However, for NRM, multivariable analysis demonstrated pretransplant diabetes (HR = 2.17, 95% CI = 1.31‐3.60, P = .003) and cardiovascular comorbidity (HR = 1.78, 95% CI = 1.15‐2.76, P = .01) to be independent predictors of NRM post‐transplant.
Conclusion
Among the comorbidities that compose the HCT‐CI, diabetes and cardiovascular comorbidity independently predict NRM in patients undergoing allogeneic HCT for AML. This information should be taken into consideration regarding post‐transplant monitoring and care.