Novel composite health assessment risk model for older allogeneic transplant recipients: BMT-CTN 1704
Mohamed L. Sorror, Wael Saber, Brent R. Logan, Nancy L. Geller, Anna Bellach, Jianqun Kou, William A. Wood, John M. McCarty, Thomas G. Knight, Lyndsey Runaas, Laura Johnston, Jeremy Walston, Ryotaro Nakamura, Lori Jarrett, Asmita Mishra, Joseph P. Uberti, Parastoo B. Dahi, Jennifer N. Saultz, Shannon R. McCurdy, Lawrence E. Morris, Philip Imus, William J. Hogan, Kalyan Nadiminti, Vijaya Raj Bhatt, Rebecca L. Olin, Joseph Maakaron, Ronald Sobecks, Sarah Wall, Deborah Mattila, Bailey Protz, Steven M. Devine, Mary M. Horowitz, Andrew Artz
Abstract
ABSTRACT: Allogeneic hematopoietic cell transplantation (allo-HCT) is potentially curative for older adults with hematologic malignancies. Concerns on nonrelapse mortality (NRM) in older adults limit allo-HCT utilization. We executed a prospective, observational study BMT-CTN 1704 (Blood and Marrow Transplant Clinical Trials Network) enrolling allo-HCT recipients aged ≥60 years from 49 centers in the United States. We analyzed associations between 13 measurements of older adult health and NRM within 1 year to construct a comprehensive health assessment risk model (primary-CHARM) using multivariate Fine-Gray model and grouped penalized variable selection. Two machine learning (ML) models (Cox and pseudo-value boosting) were also explored. Models' performances were compared using area under the curve (AUC), with bootstrap and cross-validation sampling to correct for optimism, decision curve analysis (DCA), calibration, and Brier scores. Among 1105 patients with median age of 67 (range, 60-82) years who received allo-HCT, NRM was 14.4% and overall survival (OS) 71.7% at 1 year. Factors statistically selected for inclusion in primary-CHARM were higher comorbidity burden, lower albumin, higher C-reactive protein, older age, higher weight-loss percentage, lower patient-reported performance score, and cognitive impairment. Primary-CHARM scores were independently associated with higher NRM (hazard ratio [HR], 2.72; P < .0001) and worse OS (HR, 2.09; P < .0001). Bootstrap bias-corrected AUC for primary-CHARM was 0.591. Comparing primary-CHARM with HCT-comorbidity index and 2 ML-CHARM models, calibration, Brier score, and DCA analysis favored primary-CHARM. Primary-CHARM, with mostly simple and readily available parameters, risk stratifies older adults for allo-HCT. Adopting primary-CHARM in practice may promote broader use of HCT by quantifying risk and enhance the design of strategies to improve outcomes. This trial was registered at www.ClinicalTrials.gov as #NCT03992352.