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Impact of a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), on allogeneic transplant outcomes in patients with acute myeloid leukemia and myelodysplastic syndrome.
- Source :
-
Bone marrow transplantation [Bone Marrow Transplant] 2019 Jun; Vol. 54 (6), pp. 839-848. Date of Electronic Publication: 2018 Sep 26. - Publication Year :
- 2019
-
Abstract
- Outcomes after allogeneic stem-cell transplantation (AHSCT) are influenced by both disease- and patient-related factors. Here, we developed a novel prognostic model, hematopoietic cell transplant-composite risk (HCT-CR), by combining the refined disease risk index (DRI-R) and hematopoietic stem-cell transplant comorbidity/age index (HCT-CI/Age) to predict post-transplant survival for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). The analysis included 942 AML/MDS patients treated with AHSCT. Patients were stratified into 4 HCT-CR risk groups: Low-risk-patients with low/intermediate DRI-R and HCT-CI/Age ≤3 (N = 272); Intermediate-risk-patients with low/intermediate DRI-R and HCT-CI/Age >3 (N = 168); High-risk-patients with high/very high DRI-R and HCT-CI/Age ≤3 (N = 284); and Very high-risk-patients with high/very high DRI-R and HCT-CI/Age >3 (N = 184). Compared with the low-risk group, intermediate, high, and very high-risk groups had a significantly increased risk of death [adjusted HR of 1.37 (P < 0.04), 2.08 (P < 0.001), and 2.92 (P < 0.001), respectively]. The concordance test showed that the HCT-CR model provided better discriminative capacity for OS prediction compared with all prior models independently, including cytogenetic risk group, DRI-R, and HCT-CI/Age model (C-indices: 0.62, 0.55, 0.60, and 0.54, respectively) (P < 0.001). In conclusion, combining disease- and patient-related factors provides better survival stratification for patients with AML/MDS receiving AHSCT.
- Subjects :
- Adolescent
Adult
Aged
Female
Humans
Leukemia, Myeloid, Acute mortality
Leukemia, Myeloid, Acute pathology
Male
Middle Aged
Myelodysplastic Syndromes mortality
Myelodysplastic Syndromes pathology
Prognosis
Survival Rate
Treatment Outcome
Young Adult
Hematopoietic Stem Cell Transplantation methods
Leukemia, Myeloid, Acute therapy
Myelodysplastic Syndromes therapy
Transplantation Conditioning methods
Transplantation, Homologous methods
Subjects
Details
- Language :
- English
- ISSN :
- 1476-5365
- Volume :
- 54
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Bone marrow transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 30258129
- Full Text :
- https://doi.org/10.1038/s41409-018-0344-9