Effect of comorbidities on allogeneic hematopoietic stem cell transplant outcomes in AML/MDS patients in first complete remission

Abstract

Introduction: Comorbidities can have significant impact on both survival and treatment selection in several types of malignancies. However, little attention has been paid in the literature to assess the effect of comorbidity on transplant outcomes in hematologic malignancies. We studied the impact of comorbidities on outcomes of allogeneic hematopoietic stem cell transplant (HSCT) in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients in 1st complete remission (CR). Methods: Seventy-eight patients with AML or MDS who received a matched or partially mismatched bone marrow, peripheral blood or cord blood transplant from a related or unrelated donor between January 1990 and December 2001 at the University of Texas MD Anderson Cancer Center were retrospectively reviewed. Data on demographics, comorbid conditions, and transplant outcomes were collected from the Blood and Marrow Transplantation database, patient charts and institutional electronic clinical information retrieval system. Charlson Comorbidity Index (CCI) was used to score comorbid conditions and CCI score was calculated for each patient as a weighted score of the patient’s total comorbid conditions. Results: Median age was 37 years (17–67). There were 43 males μ 35 females. Conditioning was with Thiotepa/Busulfan (Bu)/Cytoxan (Cy), Decitabine/Bu/Cy or Bu/Cy in 18 patients, Fludarabine (Flu)/Melphalan in 9 patients, Flu/Ara-C/Idarubicin in 9 patients, Flu/Bu in 7 and TBI based regimen in 35 patients. Sixty-four patients received stem cells from a sibling donor and 14 from other related or unrelated donors. Analysis was performed comparing patients with a CCI score of 0–2 with patients who had a score >2. These groups were also compared for patients who had age as comorbidity and for patients who did not (age < 40 yrs). Univariate analysis showed that patients with CCI score of 0–2 had a better overall and event free survival (OS/EFS) than patients who had CCI score >2 (Table 1). CCI score >2 was also predictive of non-relapse mortality (NRM). Moreover, CCI score was a stronger predictor of OS, EFS and NRM in patients aged <40 years. Conclusions: These results demonstrate the relevance of a standardized comorbidity score in predicting transplant outcomes in a relatively homogenous population. Our analysis indicates that CCI score can segregate patients into low or high risk for NRM and is predictive of OS and EFS in AML/MDS patients who received an allogeneic HSCT in 1st CR. TableEffect of Comorbidity Scores on Allogeneic Transplant Outcomes in AML/MDS PatientsOutcomes for all patientsCCI Score 0–2 (N = 28)CCI Score >2 (N = 50)P value% OS @ 2 yrs.83530.001% EFS @ 2 yrs.76380.0004% NRM Day1003140.02% NRM Day3604260.02Outcomes for pts <40 yrs oldCCI Score 0–2 (N = 24)CCI Score >2 (N = 21)P value% OS @ 2 yrs.91450.0009% EFS @ 2 yrs.83320.0008% NRM Day1000250.005% NRM Day3600250.005 Open table in a new tab