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. 2024 Mar 26;8(6):1359-1368.
doi: 10.1182/bloodadvances.2023011837.

Development of an umbilical cord blood transplantation-specific nonrelapse mortality risk assessment score

Yosuke Okada  1 , Yoshiaki Usui  2 , Hiromi Hayashi  3 , Masashi Nishikubo  4 , Tomomi Toubai  5 , Naoyuki Uchida  6 , Masatsugu Tanaka  7 , Makoto Onizuka  8 , Satoshi Takahashi  9 , Noriko Doki  10 , Yasufumi Uehara  11 , Yumiko Maruyama  12 , Kazuya Ishiwata  13 , Toshiro Kawakita  14 , Masashi Sawa  15 , Tetsuya Eto  16 , Fumihiko Ishimaru  17 , Koji Kato  18 , Takahiro Fukuda  19 , Yoshiko Atsuta  20   21 , Junya Kanda  22 , Kimikazu Yakushijin  23 , Hideki Nakasone  1   24
Affiliations

Development of an umbilical cord blood transplantation-specific nonrelapse mortality risk assessment score

Yosuke Okada et al. Blood Adv. .

Abstract

Higher rate of nonrelapse mortality (NRM) remains yet to be resolved in umbilical cord blood transplantation (UCBT). Considering that UCBT has some unique features compared with allogeneic hematopoietic cell transplantation from other graft sources, a UCBT-specific NRM risk assessment system is required. Thus, in this study, we sought to develop a UCBT-specific NRM Risk Assessment (CoBRA) score. Using a nationwide registry database, we retrospectively analyzed 4437 recipients who had received their first single-unit UCBT. Using the backward elimination method, we constructed the CoBRA score in a training cohort (n = 2687), which consisted of recipients age ≥55 years (score 2), hematopoietic cell transplantation-specific comorbidity index ≥3 (score 2), male recipient, graft-versus-host disease prophylaxis other than tacrolimus in combination with methotrexate, performance status (PS) 2 to 4, HLA allele mismatch ≥ 2, refined Disease Risk Index high risk, myeloablative conditioning, and CD34+ cell doses < 0.82 × 105/kg (score 1 in each). The recipients were categorized into 3 groups: low (0-4 points), intermediate (5-7 points), and high (8-11 points) groups according to the CoBRA score. In the validation cohort (n = 1750), the cumulative incidence of NRM at 2 years was 14.9%, 25.5%, and 47.1% (P < .001), and 2-year overall survival (OS) was 74.2%, 52.7%, and 26.3% (P < .001) in the low, intermediate, and high groups, respectively. In summary, the CoBRA score could predict the NRM risk as well as OS after UCBT. Further external validation will be needed to confirm the significance of the CoBRA score.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Multivariable analysis for NRM in the training cohort. A Fine and Gray proportional hazards regression model was used to evaluate the effects of covariates on the cumulative incidence of NRM. MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasms.
Figure 2.
Figure 2.
NRM and OS in the training cohort. (A) The cumulative incidence of NRM and (B) OS in the low-, intermediate-, and high-score groups.
Figure 3.
Figure 3.
NRM and OS in the validation cohort. (A) The cumulative incidence of NRM and (B) OS in the low-, intermediate-, and high-score groups.
See this image and copyright information in PMC

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