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Expanded HCT-CI Definitions Capture Comorbidity Better for Younger Patients of Allogeneic HCT for Non-Malignant Diseases

Broglie, Larisa ; Friend, Brian D. ; Chhabra, Saurabh ; Logan, Brent R. ; Bupp, Caitrin ; Schiller, Gary ; Savani, Bipin N. ; Stadtmauer, Edward ; Abraham, Allistair A. ; Aljurf, Mahmoud ; Badawy, Sherif M. ; Perez, Miguel Angel Diaz ; Guinan, Eva C. ; Hashem, Hasan ; Krem, Maxwell M. ; Lazarus, Hillard M. ; Rotz, Seth J. ; Wirk, Baldeep ; Yared, Jean A. ; Pasquini, Marcelo ; Thakar, Monica S. ; Sorror, Mohamed L.

Transplantation and cellular therapy, 2022-11, Vol.29 (2), p.125.e1-125.e9 [Periódico revisado por pares]

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  • Título:
    Expanded HCT-CI Definitions Capture Comorbidity Better for Younger Patients of Allogeneic HCT for Non-Malignant Diseases
  • Autor: Broglie, Larisa ; Friend, Brian D. ; Chhabra, Saurabh ; Logan, Brent R. ; Bupp, Caitrin ; Schiller, Gary ; Savani, Bipin N. ; Stadtmauer, Edward ; Abraham, Allistair A. ; Aljurf, Mahmoud ; Badawy, Sherif M. ; Perez, Miguel Angel Diaz ; Guinan, Eva C. ; Hashem, Hasan ; Krem, Maxwell M. ; Lazarus, Hillard M. ; Rotz, Seth J. ; Wirk, Baldeep ; Yared, Jean A. ; Pasquini, Marcelo ; Thakar, Monica S. ; Sorror, Mohamed L.
  • É parte de: Transplantation and cellular therapy, 2022-11, Vol.29 (2), p.125.e1-125.e9
  • Notas: The study was designed by LB, BF, MT, MS, GS, MP, and SC. The data analysis was performed by CF and BL. The initial draft of the manuscript was written by LB and edited by all authors. All authors agreed to the final manuscript.
    AUTHORSHIP CONTRIBUTIONS
    Authors contributed equally as last authors
    Authors contributed equally as first authors
  • Descrição: Allogeneic hematopoietic cell transplantation (HCT) can cure many non-malignant conditions but concern for morbidity and mortality remains. To help physicians estimate patient-specific transplant mortality risk, the HCT comorbidity index (HCT-CI) is used. However, paediatric physicians use the HCT-CI less frequently than adult counterparts. We used the Center for International Blood and Marrow Transplant Research database to expand the HCT-CI comorbidity definitions to be more inclusive of children, adolescents and young adults (AYA) patients, adding history of mechanical ventilation, history of invasive fungal infection, assessment of chronic kidney disease (CKD) by estimated glomerular filtration rate, expanding the definition of obesity, and adding an underweight category. A total of 2,815 children and AYAs (<40yo) who received first allogeneic HCT for non-malignant diseases from 2008–2017 were included to create an expanded youth non-malignant HCT-CI (expanded ynHCT-CI) and a simplified non-malignant (simplified ynHCT-CI) HCT-CI. The expanded comorbidities occurred frequently – history of mechanical ventilation (9.6%), history of invasive fungal infection (5.9%), mild CKD (12.2%), moderate/severe CKD (2.1%), obesity (10.9%), underweight (14.5%). 39% of patients had an increase in their comorbidity score using the expanded ynHCT-CI, leading to a redistribution of scores: ynHCT-CI score 0 (35%), 1–2 (36.4%), and ≥3 (28.6%). Patients with an increase in their comorbidity score had an increased hazard of mortality compared to those whose score remained the same (HR 1.41, 95% CI 1.01–1.98). Modifications to the HCT-CI can benefit children and AYA patients with non-malignant diseases, creating a risk assessment tool that is clinically relevant and better captures comorbidity in this younger population.
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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