The Simplified Comorbidity Index: a new tool for prediction of nonrelapse mortality in allo-HCT
Roni Shouval, Joshua Fein, Christina Cho, Scott T. Avecilla, Josel D. Ruiz, Ana Alarcón Tomás, Miriam Sánchez‐Escamilla, Nerea Castillo Flores, Lucrecia Yáñez, Juliet N. Barker, Parastoo B. Dahi, Sergio Giralt, Alexander Geyer, Boglarka Gyurkocza, Ann A. Jakubowski, Richard J. Lin, Richard J. O’Reilly, Esperanza B. Papadopoulos, Ioannis Politikos, Doris M. Ponce, Craig S. Sauter, Michael Scordo, Brian C. Shaffer, Gunjan L. Shah, James Sullivan, Roni Tamari, Marcel R.M. van den Brink, James W. Young, Arnon Nagler, Sean M. Devlin, Avichai Shimoni, Miguel‐Angel Perales
Abstract
Individual comorbidities have distinct contributions to nonrelapse mortality (NRM) following allogeneic hematopoietic cell transplantation (allo-HCT). We studied the impact of comorbidities individually and in combination in a single-center cohort of 573 adult patients who underwent CD34-selected allo-HCT following myeloablative conditioning. Pulmonary disease, moderate to severe hepatic comorbidity, cardiac disease of any type, and renal dysfunction were associated with increased NRM in multivariable Cox regression models. A Simplified Comorbidity Index (SCI) composed of the 4 comorbidities predictive of NRM, as well as age >60 years, stratified patients into 5 groups with a stepwise increase in NRM. NRM rates ranged from 11.4% to 49.9% by stratum, with adjusted hazard ratios of 1.84, 2.59, 3.57, and 5.38. The SCI was also applicable in an external cohort of 230 patients who underwent allo-HCT with unmanipulated grafts following intermediate-intensity conditioning. The area under the receiver operating characteristic curve (AUC) of the SCI for 1-year NRM was 70.3 and 72.0 over the development and external-validation cohorts, respectively; corresponding AUCs of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) were 61.7 and 65.7. In summary, a small set of comorbidities, aggregated into the SCI, is highly predictive of NRM. The new index stratifies patients into distinct risk groups, was validated in an external cohort, and provides higher discrimination than does the HCT-CI.