The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation

Shlomo Elias; Samantha Brown; Sean M. Devlin; Juliet N. Barker; Christina Cho; David J. Chung; Parastoo B. Dahi; Sergio Giralt; Boglarka Gyurkocza; Ann A. Jakubowski; Oscar B. Lahoud; Heather Landau; Richard J. Lin; Esperanza B. Papadopoulos; Ioannis Politikos; Doris M. Ponce; Michael Scordo; Brian C. Shaffer; Gunjan L. Shah; Roni Tamari; James W. Young; Miguel Angel Perales; Roni Shouval

doi:10.1111/bjh.19055

The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation

Shlomo Elias, Samantha Brown, Sean M. Devlin, Juliet N. Barker, Christina Cho, David J. Chung, Parastoo B. Dahi, Sergio Giralt, Boglarka Gyurkocza, Ann A. Jakubowski, Oscar B. Lahoud, Heather Landau, Richard J. Lin, Esperanza B. Papadopoulos, Ioannis Politikos, Doris M. Ponce, Michael Scordo, Brian C. Shaffer, Gunjan L. Shah, Roni TamariJames W. Young, Miguel Angel Perales, Roni Shouval

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Comorbidity assessment before allogeneic haematopoietic cell transplantation (allo-HCT) is essential for estimating non-relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of ‘high-yield’ comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34-selected allo-HCT. Here, we evaluated the SCI in a single-centre cohort of 327 patients receiving reduced-intensity conditioning followed by unmanipulated allografts from HLA-matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0–1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3-year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all-cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1-, 2- and 3-year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo-HCT from HLA-matched donors after reduced-intensity conditioning.

Original language	English
Pages (from-to)	840-851
Number of pages	12
Journal	British Journal of Haematology
Volume	203
Issue number	5
Early online date	24 Aug 2023
DOIs	https://doi.org/10.1111/bjh.19055
State	Published - Dec 2023
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2023 British Society for Haematology and John Wiley & Sons Ltd.

Funding

The research was supported in part by the Memorial Sloan Kettering Cancer Center Core grant (P30 CA008748) from the National Institutes of Health/National Cancer Institute. RS was supported by the American Society of Transplantation and Cellular Therapy New Investigator Award, the American Society of Hematology Fellow Scholar Award, a grant from the Long Island Sound Chapter, Swim Across America, the Robert Hirschhorn Award, the Memorial Sloan Kettering Steven Greenberg Lymphoma Research and the Lymphoma Research Foundation Career Development Award. SE is supported by the American Society of Hematology Global Research Award and by Hadassah “OFEK” research award. The graphical abstract was created with BioRender.com .

Funders	Funder number
Long Island Sound Chapter
National Institutes of Health
National Cancer Institute
American Society of Hematology
American Society for Transplantation and Cellular Therapy
Swim Across America

Keywords

Simplified Comorbidity Index
allogeneic haematopoietic cell transplantation
comorbidity
non-relapse mortality

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10.1111/bjh.19055

Cite this

Elias, S., Brown, S., Devlin, S. M., Barker, J. N., Cho, C., Chung, D. J., Dahi, P. B., Giralt, S., Gyurkocza, B., Jakubowski, A. A., Lahoud, O. B., Landau, H., Lin, R. J., Papadopoulos, E. B., Politikos, I., Ponce, D. M., Scordo, M., Shaffer, B. C., Shah, G. L., ... Shouval, R. (2023). The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation. British Journal of Haematology, 203(5), 840-851. https://doi.org/10.1111/bjh.19055

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title = "The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation",

abstract = "Comorbidity assessment before allogeneic haematopoietic cell transplantation (allo-HCT) is essential for estimating non-relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of {\textquoteleft}high-yield{\textquoteright} comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34-selected allo-HCT. Here, we evaluated the SCI in a single-centre cohort of 327 patients receiving reduced-intensity conditioning followed by unmanipulated allografts from HLA-matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0–1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3-year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all-cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1-, 2- and 3-year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo-HCT from HLA-matched donors after reduced-intensity conditioning.",

keywords = "Simplified Comorbidity Index, allogeneic haematopoietic cell transplantation, comorbidity, non-relapse mortality",

author = "Shlomo Elias and Samantha Brown and Devlin, {Sean M.} and Barker, {Juliet N.} and Christina Cho and Chung, {David J.} and Dahi, {Parastoo B.} and Sergio Giralt and Boglarka Gyurkocza and Jakubowski, {Ann A.} and Lahoud, {Oscar B.} and Heather Landau and Lin, {Richard J.} and Papadopoulos, {Esperanza B.} and Ioannis Politikos and Ponce, {Doris M.} and Michael Scordo and Shaffer, {Brian C.} and Shah, {Gunjan L.} and Roni Tamari and Young, {James W.} and Perales, {Miguel Angel} and Roni Shouval",

note = "Publisher Copyright: {\textcopyright} 2023 British Society for Haematology and John Wiley & Sons Ltd.",

year = "2023",

month = dec,

doi = "10.1111/bjh.19055",

language = "אנגלית",

volume = "203",

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Elias, S, Brown, S, Devlin, SM, Barker, JN, Cho, C, Chung, DJ, Dahi, PB, Giralt, S, Gyurkocza, B, Jakubowski, AA, Lahoud, OB, Landau, H, Lin, RJ, Papadopoulos, EB, Politikos, I, Ponce, DM, Scordo, M, Shaffer, BC, Shah, GL, Tamari, R, Young, JW, Perales, MA & Shouval, R 2023, 'The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation', British Journal of Haematology, vol. 203, no. 5, pp. 840-851. https://doi.org/10.1111/bjh.19055

TY - JOUR

T1 - The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation

AU - Elias, Shlomo

AU - Brown, Samantha

AU - Devlin, Sean M.

AU - Barker, Juliet N.

AU - Cho, Christina

AU - Chung, David J.

AU - Dahi, Parastoo B.

AU - Giralt, Sergio

AU - Gyurkocza, Boglarka

AU - Jakubowski, Ann A.

AU - Lahoud, Oscar B.

AU - Landau, Heather

AU - Lin, Richard J.

AU - Papadopoulos, Esperanza B.

AU - Politikos, Ioannis

AU - Ponce, Doris M.

AU - Scordo, Michael

AU - Shaffer, Brian C.

AU - Shah, Gunjan L.

AU - Tamari, Roni

AU - Young, James W.

AU - Perales, Miguel Angel

AU - Shouval, Roni

PY - 2023/12

Y1 - 2023/12

N2 - Comorbidity assessment before allogeneic haematopoietic cell transplantation (allo-HCT) is essential for estimating non-relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of ‘high-yield’ comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34-selected allo-HCT. Here, we evaluated the SCI in a single-centre cohort of 327 patients receiving reduced-intensity conditioning followed by unmanipulated allografts from HLA-matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0–1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3-year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all-cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1-, 2- and 3-year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo-HCT from HLA-matched donors after reduced-intensity conditioning.

AB - Comorbidity assessment before allogeneic haematopoietic cell transplantation (allo-HCT) is essential for estimating non-relapse mortality (NRM) risk. We previously developed the Simplified Comorbidity Index (SCI), which captures a small number of ‘high-yield’ comorbidities and older age. The SCI was predictive of NRM in myeloablative CD34-selected allo-HCT. Here, we evaluated the SCI in a single-centre cohort of 327 patients receiving reduced-intensity conditioning followed by unmanipulated allografts from HLA-matched donors. Among the SCI factors, age above 60, mild renal impairment, moderate pulmonary disease and cardiac disease were most frequent. SCI scores ranged from 0 to 8, with 39%, 20%, 20% and 21% having scores of 0–1, 2, 3 and ≥4 respectively. Corresponding cumulative incidences of 3-year NRM were 11%, 16%, 22% and 27%; p = 0.03. In multivariable models, higher SCI scores were associated with incremental risks of all-cause mortality and NRM. The SCI had an area under the receiver operating characteristic curve of 65.9%, 64.1% and 62.9% for predicting 1-, 2- and 3-year NRM versus 58.4%, 60.4% and 59.3% with the haematopoietic cell transplantation comorbidity index. These results demonstrate for the first time that the SCI is predictive of NRM in patients receiving allo-HCT from HLA-matched donors after reduced-intensity conditioning.

KW - Simplified Comorbidity Index

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KW - comorbidity

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The Simplified Comorbidity Index predicts non-relapse mortality in reduced-intensity conditioning allogeneic haematopoietic cell transplantation

Abstract

Bibliographical note

Funding

Keywords

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