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Impact of comorbidity indexes on non-relapse mortality.

Xhaard, A and Porcher, R and Chien, J W and de Latour, R P and Robin, M and Ribaud, P and Rocha, V and Devergie, A and Ferry, C and Martin, P J and Socié, G (2008) Impact of comorbidity indexes on non-relapse mortality. Leukemia : official journal of the Leukemia Society of America, Leukemia Research Fund, U.K, 22 (11). pp. 2062-2069. ISSN 1476-5551

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Article URL: http://www.nature.com/leu/journal/v22/n11/abs/leu2...

Abstract

Comorbidity indexes (CI) have been reported to predict non-relapse mortality (NRM) and overall survival after allogeneic hematopoietic stem cell transplantation (HSCT) (Charlson's comorbidity index (CCI), hematopoietic cell transplantation CI (HCT-CI) and the pre-transplantation assessment of mortality (PAM) score). Which of these indexes best predict survival is unknown yet. We retrospectively studied 286 patients who underwent allogeneic HSCT. HCT-CI and PAM scores required grading according to pre-transplant pulmonary function tests (PFTs), which were lacking for some patients. We thus designed a reduced HCT-CI and an adjusted PAM, without results of PFTs. Using CCI, 25% of patients had indexes of 1 or more; median reduced HCT-CI score was 1; median adjusted PAM score was 24. The discriminative properties of the three CIs were rather low in our population. Comparison of patients and transplant characteristics between our and Seattle group's cohorts, however, revealed significant differences in more children, in more cord blood HSCT and in HSCT for Fanconi anemia in St Louis. Finally, multivariate analysis of scoring items revealed that age, matched unrelated or mismatched donor and hepatic disease were associated with NRM in our cohort. Translating use for patient's counseling or decision to proceed to transplant of these CIs will need prospective studies in a large independent cohort.

Item Type: Article
Additional Information: This article is available to subscribers only at the Article URL above.
DOI: 10.1038/leu.2008.197
PubMed ID: 18685612
NIHMSID: NIHMS82860
PMCID: PMC2637383
Grant Numbers: P01 CA018029-33, P01 HL036444-28
Keywords or MeSH Headings: Adolescent Adult Child Child, Preschool Comorbidity Cord Blood Stem Cell Transplantation/mortality* Fanconi Anemia/mortality* Fanconi Anemia/therapy Female Follow-Up Studies Hematopoietic Stem Cell Transplantation/mortality* Hodgkin Disease/mortality* Hodgkin Disease/therapy Humans Leukemia/mortality* Leukemia/therapy Male Middle Aged Myelodysplastic Syndromes/mortality* Myelodysplastic Syndromes/therapy Prognosis Remission Induction Retrospective Studies Risk Factors Survival Rate Transplantation, Homologous Young Adult
Subjects: Therapeutics > Transplantation > Stem Cell transplantation
Research Methodologies > Epidemiology > Risk assessment
Depositing User: Library Staff
Date Deposited: 12 Dec 2008 20:50
Last Modified: 14 Feb 2012 14:42
URI: http://authors.fhcrc.org/id/eprint/198

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