1. Charlson comorbidity index predicts outcomes of elderly after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and myelodysplastic syndrome.
- Author
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Chien, Sheng-Hsuan, Yao, Ming, Li, Chi-Cheng, Chang, Ping-Ying, Yu, Ming-Sun, Huang, Cih-En, Tan, Tran-Der, Lin, Cheng-Hsien, Yeh, Su-Peng, Li, Sin-syue, Wang, Po-Nan, Liu, Yi-Chang, and Gau, Jyh-Pyng
- Subjects
HEMATOPOIETIC stem cell transplantation ,ACUTE diseases ,MYELODYSPLASTIC syndromes ,ACUTE myeloid leukemia ,PROGNOSIS ,OVERALL survival ,MYELODYSPLASTIC syndromes treatment ,ACUTE myeloid leukemia treatment ,RETROSPECTIVE studies ,IMMUNOSUPPRESSION ,LONGITUDINAL method ,COMORBIDITY - Abstract
Background/purpose: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS), but advanced age with multiple comorbidities limits the eligibility for allo-HSCT. We conducted a retrospective study to investigate the comorbidities assessments and prognostic factors that predict outcomes for these patients.Methods: Clinical data of patients older than 50 years who had received diagnoses of AML or MDS and underwent allo-HSCT were obtained. Information on patient characteristics, including age, gender, allogeneic transplant type, conditioning regimens, Charlson comorbidity index (CCI), and presence of acute graft-versus-host disease (GVHD) or chronic GVHD, were collected and analyzed.Results: Two hundred fifty-five elderly patients with a median age at allo-HSCT of 57 years were included. The significant prognostic factors associated with worse overall survival (OS) were CCI ≥3 (hazard ratio: 1.88) and grade III-IV acute GVHD (3.18). Similar findings were noted in the non-relapse mortality analysis. To investigate the effects of chronic GVHD on patient outcomes, OS analysis was performed for those with survival >100 days after transplantation. The results revealed CCI ≥3 (1.88) and grade III-IV acute GVHD (2.73) remained poor prognostic factors for OS, whereas mild chronic GVHD (0.43) was associated with better OS.Conclusion: This cohort study suggests that CCI ≥3 predicts poor outcomes, primarily due to a higher NRM risk. Careful management of GVHD after transplantation could improve outcomes in elderly patients with AML or MDS after allo-HSCT. [ABSTRACT FROM AUTHOR]- Published
- 2021
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