Association of pre-existing comorbidities with outcome of allogeneic hematopoietic cell transplantation. A retrospective analysis from the EBMT

• Published in: Bone marrow transplantation (Basingstoke) Vol. 57; no. 2; pp. 183 - 190
• Main Authors: Penack, Olaf, Peczynski, Christophe, Mohty, Mohamad, Yakoub-Agha, Ibrahim, de la Camara, Rafael, Glass, Bertram, Duarte, Rafael F., Kröger, Nicolaus, Schoemans, Hélène, Koenecke, Christian, Peric, Zinaida, Basak, Grzegorz W.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-02-2022; Nature Publishing Group
• Subjects: 692/308/575; 692/499; Cell Biology; Comorbidity; Diabetes mellitus; Health hazards; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Human health and pathology; Humans; Internal Medicine; Life Sciences; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local; Public Health; Retrospective Studies; Risk analysis; Risk assessment; Risk factors; Stem cell transplantation; Stem Cells; Transplantation; Transplantation Conditioning; Transplantation, Homologous; Translational research; Risk factors
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-021-01502-8

Risk assessment of allogeneic hematopoietic cell transplantation (allo-HCT) is hindered by the lack of current data on comorbidities and outcome. The EBMT identified 38,760 allo-HCT recipients with hematologic malignancies transplanted between 2010 and 2018 from matched sibling and unrelated donors with a full data set of pre-existing comorbidities. Multivariate analyses using the Cox proportional-hazards model including known risk factors for non-relapse mortality (NRM) were performed. We found that pre-existing renal comorbidity had the strongest association with NRM (hazard ratio [HR] 1.85 [95% CI 1.55–2.19]). In addition, the association of multiple pre-existing comorbidities with NRM was significant, including diabetes, infections, cardiac comorbidity, and pulmonary comorbidity. However, the HR of the association of these comorbidities with NRM was relatively low and did not exceed 1.24. Consequently, the risk of NRM was only moderately increased in patients with a high hematopoietic cell transplantation comorbidity index (HCT-CI) ≥ 3 (HR 1.34 [1.26–1.42]). In the current EBMT population, pre-existing non-renal comorbidities determined NRM after allo-HCT to a much lesser extent as compared with the underlying HCT-CI data. Improvements in management and supportive care as well as higher awareness based on the use of HCT-CI may have contributed to this favorable development.