Comorbidity-Age Index: A Clinical Measure of Biologic Age Before Allogeneic Hematopoietic Cell Transplantation

医学 共病 内科学 危险系数 移植 造血细胞 造血干细胞移植 比例危险模型 置信区间 造血 干细胞 遗传学 生物
作者
Mohamed L. Sorror,Rainer Storb,Brenda M. Sandmaier,Richard T. Maziarz,Michael A. Pulsipher,Michael B. Maris,Smita Bhatia,Fabiana Ostronoff,H. Joachim Deeg,Karen L. Syrjala,Elihu H. Estey,David G. Maloney,Frederick R. Appelbaum,Paul J. Martin,Barry E. Storer
出处
期刊:Journal of Clinical Oncology [Lippincott Williams & Wilkins]
卷期号:32 (29): 3249-3256 被引量:350
标识
DOI:10.1200/jco.2013.53.8157
摘要

Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cell transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown.Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age intervals and a validation set to assess the performance of prognostic models.In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P = .29), 1.48 (P = .04), 1.75 (P = .004), and 1.84 (P = .005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P < .001) and survival (0.682 v 0.560; P < .001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens.Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.
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