The impact of individual comorbidities on non-relapse mortality following allogeneic hematopoietic stem cell transplantation

Joshua A. Fein, Avichai Shimoni, Myriam Labopin, Noga Shem-Tov, Ronit Yerushalmi, Hila Magen, Nadav Furie, Eli Kopel, Ivetta Danylesko, Arnon Nagler, Roni Shouval

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Comorbidity burden is a well-established risk factor for non-relapse mortality (NRM) following allogeneic stem cell transplantation (allo-SCT). We evaluated whether individual comorbidities could better characterize NRM risk. Furthermore, given differing toxicity profiles of conditioning agents, we hypothesized that the hazard of comorbidities is exerted in a regimen-specific manner. This retrospective study included 875 adults treated with an allo-SCT. Six conditioning regimens were considered. Across the entire cohort and within each regimen, the hazard ratio (HR) for NRM associated with individual comorbidities was assessed using multivariable Cox regressions. In the overall population, renal dysfunction, hypoalbuminemia, and severe hepatic disease were associated with the highest risk of NRM (HR 2.1, HR 1.9, HR 1.7, respectively). The risk associated with specific comorbidities was modified by the conditioning regimen and was not correlated with intensity. In patients conditioned with fludarabine/busulfan (Flu/Bu4), NRM risk was increased with cardiac disease (HR 5.54). Severe pulmonary disease and a pre-existing infection were associated with increased NRM risk in patients receiving fludarabine/melphalan (HR 4.9) and fludarabine/treosulfan (HR 3.6), respectively. Comorbidities may exert effects unique to particular conditioning regimens, suggesting that regimen selection should be driven in part by specific comorbidities.

Original languageEnglish
Pages (from-to)1787-1794
Number of pages8
JournalLeukemia
Volume32
Issue number8
DOIs
StatePublished - 1 Aug 2018

Bibliographical note

Publisher Copyright:
© 2018, Macmillan Publishers Limited, part of Springer Nature.

Funding

Acknowledgements This study was supported by The Varda and Boaz Dotan Research Center in Hemato-Oncology affiliated with the CBRC of Tel Aviv University and The Shalvi Foundation for the Support of Medical Research.

FundersFunder number
Shalvi Foundation
Tel Aviv University
Varda and Boaz Dotan Research Center for Hemato-Oncology Research, Tel Aviv University

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