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. 2019 Jun;54(6):839-848.
doi: 10.1038/s41409-018-0344-9. Epub 2018 Sep 26.

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

Piyanuch Kongtim  1   2 , Simrit Parmar  1 , Denái R Milton  3 , Jorge Miguel Ramos Perez  1 , Gabriela Rondon  1 , Julianne Chen  1 , Abhishek R Chilkulwar  1 , Gheath Al-Atrash  1 , Amin Alousi  1 , Borje S Andersson  1 , Jin S Im  1 , Chitra M Hosing  1 , Qaiser Bashir  1 , Issa Khouri  1 , Partow Kebriaei  1 , Betul Oran  1 , Uday Popat  1 , Richard Champlin  1 , Stefan O Ciurea  4
Affiliations

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

Piyanuch Kongtim et al. Bone Marrow Transplant. 2019 Jun.

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.

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Conflict of interest statement

Competing interests: The authors have no competing financial interests to disclose for this work.

Figures

Figure 1.
Figure 1.
The classification and regression trees (CART) analysis in a training cohort
Figure 2.
Figure 2.
Overall survival by the hematopoietic cell transplant - composite risk groups (A), cytogenetic risk groups (B), DRI-R (C) and HCT-CI/Age (D)
Figure 2.
Figure 2.
Overall survival by the hematopoietic cell transplant - composite risk groups (A), cytogenetic risk groups (B), DRI-R (C) and HCT-CI/Age (D)
Figure 2.
Figure 2.
Overall survival by the hematopoietic cell transplant - composite risk groups (A), cytogenetic risk groups (B), DRI-R (C) and HCT-CI/Age (D)
Figure 2.
Figure 2.
Overall survival by the hematopoietic cell transplant - composite risk groups (A), cytogenetic risk groups (B), DRI-R (C) and HCT-CI/Age (D)
See this image and copyright information in PMC

References

    1. Koreth J, Schlenk R, Kopecky KJ, Honda S, Sierra J, Djulbegovic BJ, et al. Allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission: systematic review and meta-analysis of prospective clinical trials. Jama. 2009;301(22):2349–61. - PMC - PubMed
    1. Weisdorf DJ, Millard HR, Horowitz MM, Hyare PS, Champlin R, Ho V, et al. Allogeneic transplantation for advanced acute myeloid leukemia: The value of complete remission. Cancer. 2017;123(11):2025–34. - PMC - PubMed
    1. Di Stasi A, Milton DR, Poon LM, Hamdi A, Rondon G, Chen J, et al. Similar transplantation outcomes for acute myeloid leukemia and myelodysplastic syndrome patients with haploidentical versus 10/10 human leukocyte antigen-matched unrelated and related donors. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 2014;20(12):1975–81. - PMC - PubMed
    1. Ciurea SO, Zhang MJ, Bacigalupo AA, Bashey A, Appelbaum FR, Aljitawi OS, et al. Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia. Blood. 2015;126(8):1033–40. - PMC - PubMed
    1. Ballen KK, Lazarus H. Cord blood transplant for acute myeloid leukaemia. British journal of haematology. 2016;173(1):25–36. - PubMed

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