Conference Coverage

Simplified HCT-CI better predicts outcomes in young patients



– A revised hematopoietic stem cell transplantation comorbidity index developed for adolescents and young adults is useful for predicting nonrelapse mortality in this specific population, according to Brian Friend, MD.

In a retrospective study of 241 patients aged 15-39 years who underwent a first allogeneic hematopoietic stem cell transplant (HCT) between 2005 and 2015 at the University of California, Los Angeles, nonrelapse mortality incidence was particularly high, with rates of 26%, 28%, and 30% at 1, 2, and 3 years, respectively, Dr. Friend, a clinical research fellow at the David Geffen School of Medicine, Los Angeles, reported in a poster at the Acute Leukemia Forum of Hemedicus.

Dr. Brian Friend, a clinical research fellow at the David Geffen School of Medicine, Los Angeles Sharon Worcester/MDedge News

Dr. Brian Friend

Notably, 60% of the comorbidities included in the commonly used HCT–Comorbidity Index (HCT-CI) did not have significant prevalence in these patients, and the index did not appear useful for predicting overall survival or nonrelapse mortality, he said in an interview.

Rather, a history of pulmonary disease – found in 44% of the patients – was the most common comorbidity, and although this was based on pulmonary function tests alone and not necessarily on patient symptoms, it was a surprising finding, he said. It was associated with lower overall survival and with nonrelapse mortality, he added.

A psychosocial component, which took into account factors such as stressors, social support, financial issues, and substance abuse, was also fairly frequent in the patients, but was not necessarily associated with worse outcomes, he noted.

“In multivariable analysis, only a history of prior malignancy (hazard ratio, 2.04) and moderate and severe pulmonary disease (hazard ratios, 1.39 and 1.84, respectively) were associated with a higher incidence of nonrelapse mortality,” he reported.

The existing HCT-CI was developed in adults to help risk-stratify patients undergoing transplant, but adolescents and young adults undergoing HCT tend to have fewer comorbidities compared with older adults, though they still having a significant nonrelapse mortality rate, Dr. Friend said.


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