Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study
Yıl: 2021 Cilt: 38 Sayı: 2 Sayfa Aralığı: 138 - 144 Metin Dili: İngilizce DOI: 10.4274/tjh.galenos.2020.2020.0178 İndeks Tarihi: 21-06-2022
Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study
Öz: Objective: Allogeneic hematopoietic stem cell transplantation (AHSCT)
is a potentially curative treatment of choice for many hematological
diseases. However, there are some transplantation-related risks.
Predicting the risk-benefit ratio prior to AHSCT facilitates the choice
of conditioning regimens and posttransplant follow-up. Hence, many
risk models have been developed. The aim of the present study was to
compare 6 different risk models that are clinically used.
Materials and Methods: A total of 259 patients were enrolled in this
study. The European Society for Blood and Marrow Transplantation
(EBMT), Hematopoietic Cell Transplantation Comorbidity Index
(HCT-CI), Age-Adjusted Hematopoietic Cell Transplantation
Comorbidity Index (HCT-CI-Age), revised Pretransplant Assessment of
Mortality (rPAM), Acute Leukemia-EBMT (AL-EBMT), and Disease Risk
Index (DRI) risk models were applied retrospectively.
Results: The AL-EBMT, HCT-CI, and HCT-CI-Age scoring systems were
found to be predictive for 2-year overall survival (OS) and 2-year
non-relapse mortality (NRM) (2-year OS: AL-EBMT, reference vs.
score 8.5-10, HR: 1.3, p=0.035; AL-EBMT, reference vs. score >10, HR:
3.8, p=0.001; HCT-CI: reference vs. score 1-2, HR: 1.4, p=0.018; HCT-
CI: reference vs. score ≥3, HR: 2.5, p<0.001; HCT-CI-Age: reference
vs. score 1-2, HR: 1.3, p<0.001; HCT-CI-Age: reference vs. score ≥3,
HR: 3.2, p<0.001) (2-year NRM: AL-EBMT: reference vs. score 8.5-10,
HR: 1.61, p<0.001; AL-EBMT: reference vs. score >10, HR: 3.3, p<0.001;
HCT-CI: reference vs. score 1-2, HR: 1.3, p=0.028; HCT-CI: reference
vs. score ≥3, HR: 2.3, p=0.011; HCT-CI-Age: reference vs. score 1-2,
HR: 1.3, p=0.01; HCT-CI-Age: reference vs. score ≥3, HR: 2.4, p=0.003).
In terms of the Kaplan-Meier estimates of 2-year OS and 2-year NRM,
the risk scoring system with the highest predictive power was found
to be AL-EBMT (2-year AUC: 0.59 and 0.60, respectively). The other
scores were not found to be predictive for 2-year OS and NRM.
Conclusion: In the present study at our bone marrow and stem cell
transplant center, it has been demonstrated that the HCT-CI, HCT-CI-
Age, and AL-EBMT are good predictors of 2-year NRM and OS.
Anahtar Kelime: HLA-Uyumlu Allojenik Hematopoetik Kök Hücre Akraba Nakillerinde Risk Skor Sistemlerinin Kıyaslanması: Retrospektif Kohort Çalışması
Öz: Amaç: Allojeneik hematopoetik kök hücre nakli (AHKHN) birçok
hematolojik hastalıkta kullanılan potansiyel küratif bir tedavi
seçeneğidir. Bununla birlikte nakil ilişkili bazı riskler bulunmaktadır.
AHKHN öncesi risk-fayda oranının belirlenmesi, kullanılacak hazırlık
rejimlerinin seçimi ve nakil sonrası hasta takibini kolaylaştırmaktadır.
Bu nedenle birçok risk modeli geliştirilmiştir. Bu çalışmanın amacı,
klinik kullanımı olan 6 farklı risk modelini karşılaştırılmasıdır.
Gereç ve Yöntemler: Bu çalışmaya çeşitli hematolojik nedenlerle
AHKHN yapılan 259 hasta alınmıştır. Avrupa Kan ve Kemik iliği Nakli
Derneği (EBMT), Hematopoetik Hücre Transplantasyon Komorbidite
İndeksi (HCT-CI), yaşa göre düzenlenmiş Hematopoetik Hücre
Transplantasyon Komorbidite İndeksi (HCT-CI-Yaş), düzenlenmiş nakil
öncesi mortalite değerlendirme skoru (rPAM), akut lösemi-EBMT skoru
(AL-EBMT) ve hastalık risk indeksi (DRI) risk modelleri geriye dönük
olarak uygulanmıştır.
Bulgular: HCT-CI, HCT-CI-Age ve AL-EBMT risk modelleri 2 yıllık
genel sağkalım (OS) ve 2 yıllık NRM için prediktif bulundu (2 yıllık OS;
AL-EBMT: referans vs skor 8,5-10 HR: 1,3 p=0,035 referans vs skor
>10 HR: 3,8 p=0,001, HCT-CI: referans vs score 1-2 HR: 1,4 p=0,018
referans vs skor ≥3 HR: 2,5 p<0.001, HCT-CI-Age referans vs skor
1-2 HR: 1,3 p<0,001 referans vs skor ≥3 HR: 3,2 p<0,001 2 yıllık
NRM: AL-EBMT: referans vs skor 8,5-10 HR: 1,61 p<0,001 referans vs
skor >10 HR: 3,3 p<0,001 HCT-CI: referans vs skor 1-2 HR: 1,3 p=0,028
referans vs skor ≥3 HR: 2,3 p=0,011 HCT-CI-Age referance vs skor
1-2 HR: 1,3 p=0,01 referans vs skor ≥3 HR: 2,4 p=0,003). İki yıllık OS
ve 2 yıllık NRM için, prediktif gücü en yüksek olan test AL-EBMT idi
(sırasıyla 2 yıllık AUC; 0,59-0,60). Diğer modeller 2 yıllık OS ve NRM
için prediktif değildi.
Sonuç: Referans nakil merkezimizde yapılan bu çalışmada, HCT-CI,
HCT-CI-Yaş ve AL-EBMT risk modellerinin 2 yıllık NRM ve OS için iyi
birer belirteç olduğu gösterilmiştir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Singh AK, McGuirk JP. Allogeneic stem cell transplantation: a historical and scientific overview. Cancer Res 2016;76:6445-6451.
- 2. Fein JA, Shimoni A, Labopin M, Shem-Tov N, Yerushalmi R, Magen H, Furie N, Kopel E, Danylesko I, Nagler A, Shouval R. The impact of individual comorbidities on non-relapse mortality following allogeneic hematopoietic stem cell transplantation. Leukemia 2018;32:1787-1794.
- 3. Gyurkocza B, Sandmaier BM. Conditioning regimens for hematopoietic cell transplantation: one size does not fit all. Blood 2014;124:344-353.
- 4. Elsawy M, Sorror ML. Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2016;51:1283- 1300.
- 5. Potdar R, Varadi G, Fein J, Labopin M, Nagler A, Shouval R. Prognostic scoring systems in allogeneic hematopoietic stem cell transplantation: Where do we stand? Biol Blood Marrow Transplant 2017;23:1839-1846.
- 6. Shouval R, Fein JA, Shouval A, Danylesko I, Shem-Tov N, Zlotnik M, Yerushalmi R, Shimoni A, Nagler A. External validation and comparison of multiple prognostic scores in allogeneic hematopoietic stem cell transplantation. Blood Adv 2019;3:1881-1890.
- 7. Sorror ML, Storb RF, Sandmaier BM, Maziarz RT, Pulsipher MA, Maris MB, Bhatia S, Ostronoff F, Deeg HJ, Syrjala KL, Estey E, Maloney DG, Appelbaum FR, Martin PJ, Storer BE. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol 2014;32:3249-3256.
- 8. Barba P, Martino R, Perez-Simon JA, Fernandez-Aviles F, Castillo N, Pinana JL, Lopez-Anglada L, Rovira M, Bosch F, Carreras E, Corral LL, Sierra J, Valcarcel D. Combination of the Hematopoietic Cell Transplantation Comorbidity Index and the European Group for Blood and Marrow Transplantation score allows a better stratification of high-risk patients undergoing reduced- toxicity allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2014;20:66-72.
- 9. Au BK, Gooley TA, Armand P, Fang M, Madtes DK, Sorror ML, Boeckh MJ, Gibson CJ, Deeg HJ, Storb R, Appelbaum FR, Chien JW, Martin PJ. Reevaluation of the pretransplant assessment of mortality score after allogeneic hematopoietic transplantation. Biol Blood Marrow Transplant 2015;21:848-854.
- 10. Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME, Maziarz RT, Antin JH, Soiffer RJ, Weisdorf DJ, Rizzo JD, Horowitz MM, Saber W. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood 2014;123:3664-3671.
- 11. Barba P, Pinana JL, Martino R, Valcarcel D, Amoros A, Sureda A, Briones J, Delgado J, Brunet S, Sierra J. Comparison of two pretransplant predictive models and a flexible HCT-CI using different cut off points to determine low-, intermediate-, and high-risk groups: the flexible HCT-CI Is the best predictor of NRM and OS in a population of patients undergoing allo-RIC. Biol Blood Marrow Transplant 2010;16:413-420.
- 12. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005;106:2912- 2919.
- 13. Gratwohl A. The EBMT risk score. Bone Marrow Transplant 2012;47:749- 756.
- 14. Gratwohl A, Hermans J, Goldman JM, Arcese W, Carreras E, Devergie A, Frassoni F, Gahrton G, Kolb HJ, Niederwieser D, Ruutu T, Vernant JP, de Witte T, Apperley J. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Lancet 1998;352:1087-1092.
- 15. Shouval R, Bonifazi F, Fein J, Boschini C, Oldani E, Labopin M, Raimondi R, Sacchi N, Dabash O, Unger R, Mohty M, Rambaldi A, Nagler A. Validation of the acute leukemia-EBMT score for prediction of mortality following allogeneic stem cell transplantation in a multi-center GITMO cohort. Am J Hematol 2017;92:429-434.
- 16. Parimon T, Au DH, Martin PJ, Chien JW. A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med 2006;144:407-414.
- 17. Mori Y, Teshima T, Kamezaki K, Kato K, Takenaka K, Iwasaki H, Miyamoto T, Nagafuji K, Eto T, Akashi K. Validation of pretransplantation assessment of mortality risk score in the outcome of hematopoietic SCT in non- Caucasians. Bone Marrow Transplant 2012;47:1075-1081.
- 18. Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP, Ritz J, Sorror ML, Lee SJ, Deeg HJ, Storer BE, Appelbaum FR, Antin JH, Soiffer RJ, Kim HT. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood 2012;120:905-913.
- 19. Armand P, Deeg HJ, Kim HT, Lee H, Armistead P, de Lima M, Gupta V, Soiffer RJ. Multicenter validation study of a transplantation-specific cytogenetics grouping scheme for patients with myelodysplastic syndromes. Bone Marrow Transplant 2010;45:877-885.
- 20. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V, Apperley J, Slavin S, Pasquini M, Sandmaier BM, Barrett J, Blaise D, Lowski R, Horowitz M. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 2009;15:1628-1633.
- 21. Kröger N, Iacobelli S, Franke GN, Platzbecker U, Uddin R, Hübel K, Scheid C, Weber T, Robin M, Stelljes M, Afanasyev B, Heim D, Deliliers GL, Onida F, Dreger P, Pini M, Guidi S, Volin L, Günther A, Bethge W, Poiré X, Kobbe G, van Os M, Brand R, de Witte T. Dose-reduced versus standard conditioning followed by allogeneic stem-cell transplantation for patients with myelodysplastic syndrome: a prospective randomized phase III study of the EBMT (RICMAC Trial). J Clin Oncol 2017;35:2157-2164.
- 22. Abdul Wahid SF, Ismail NA, Mohd-Idris MR, Jamaluddin FW, Tumian N, Sze-Wei EY, Muhammad N, Nai ML. Comparison of reduced-intensity and myeloablative conditioning regimens for allogeneic hematopoietic stem cell transplantation in patients with acute myeloid leukemia and acute lymphoblastic leukemia: a meta-analysis. Stem Cells Dev 2014;23:2535- 2552.
- 23. Numata A, Tanaka M, Matsumoto K, Takasaki H, Tachibana T, Fujimaki K, Sakai R, Fujisawa S, Tomita N, Fujita H, Maruta A, Ishigatsubo Y, Kanamori H. Validation of the European Group for Blood and Marrow Transplantation (EBMT) risk score in patients receiving allogeneic hematopoietic stem cell transplantation at a single center in Japan. Clin Transplant 2014;28:403-409.
- 24. Middeke JM, Kollinger F, Baldauf H, Stolzel F, Wermke M, von Bonin M, Sockel K, Link CS, Teipel R, Rollig C, Thiede C, Platzbecker U, Ehninger G, Bornhauser M, Schetelig J. Validation of the Revised Pretransplant Assessment of Mortality Score in patients with acute myelogenous leukemia undergoing allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2018;24:1947-1951.
- 25. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, Storer B. Hematopoietic cell transplantation (HCT)-specific-comorbidity index: A new tool for risk assessment before allogeneic HCT. Blood 2005;106:2912- 2919.
- 26. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383.
- 27. Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME, Maziarz RT, Antin JH, Soiffer RJ, Weisdorf DJ, Rizzo JD, Horowitz MM, Saber W. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood 2014;123:3664-3671.
- 28. Xhaard A, Porcher R, Chien JW, de Latour RP, Robin M, Ribaud P, Rocha V, Devergie A, Ferry C, Martin PJ, Socié G. Impact of comorbidity indexes on non-relapse mortality. Leukemia 2008;22:2062-2069.
- 29. Versluis J, Labopin M, Niederwieser D, Socie G, Schlenk RF, Milpied N, Nagler A, Blaise D, Rocha V, Cornelissen JJ, Mohty M. Prediction of non- relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission. Leukemia 2015;29:51-57.
- 30. Barba P, Piñana JL, Martino R, Valcárcel D, Amorós A, Sureda A, Briones J, Delgado J, Brunet S, Sierra J. Comparison of two pretransplant predictive models and a flexible HCT-CI using different cut off points to determine low-, intermediate-, and high-risk groups: the flexible HCT-CI is the best predictor of NRM and OS in a population of patients undergoing allo-RIC. Biol Blood Marrow Transplant 2010;16:413-420.
- 31. Chien JW, Sullivan KM. Carbon monoxide diffusion capacity: How low can you go for hematopoietic cell transplantation eligibility? Biol Blood Marrow Transplant 2009;15:447-453.
- 32. Ljungman P, Brand R, Hoek J, de la Camara R, Cordonnier C, Einsele H, Styczynski J, Ward KN, Cesaro S; Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the European group for blood and marrow transplantation. Clin Infect Dis 2014;59:473-481
| APA | Aladag E, Demiroglu H, BÜYÜKAŞIK Y, GOKER A (2021). Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. , 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| Chicago | Aladag Elifcan,Demiroglu Haluk,BÜYÜKAŞIK Yahya,GOKER ALI HAKAN Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. (2021): 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| MLA | Aladag Elifcan,Demiroglu Haluk,BÜYÜKAŞIK Yahya,GOKER ALI HAKAN Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. , 2021, ss.138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| AMA | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. . 2021; 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| Vancouver | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. . 2021; 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| IEEE | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A "Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study." , ss.138 - 144, 2021. 10.4274/tjh.galenos.2020.2020.0178 |
| ISNAD | Aladag, Elifcan vd. "Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study". (2021), 138-144. https://doi.org/10.4274/tjh.galenos.2020.2020.0178 |
| APA | Aladag E, Demiroglu H, BÜYÜKAŞIK Y, GOKER A (2021). Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. Turkish Journal of Hematology, 38(2), 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| Chicago | Aladag Elifcan,Demiroglu Haluk,BÜYÜKAŞIK Yahya,GOKER ALI HAKAN Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. Turkish Journal of Hematology 38, no.2 (2021): 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| MLA | Aladag Elifcan,Demiroglu Haluk,BÜYÜKAŞIK Yahya,GOKER ALI HAKAN Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. Turkish Journal of Hematology, vol.38, no.2, 2021, ss.138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| AMA | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. Turkish Journal of Hematology. 2021; 38(2): 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| Vancouver | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study. Turkish Journal of Hematology. 2021; 38(2): 138 - 144. 10.4274/tjh.galenos.2020.2020.0178 |
| IEEE | Aladag E,Demiroglu H,BÜYÜKAŞIK Y,GOKER A "Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study." Turkish Journal of Hematology, 38, ss.138 - 144, 2021. 10.4274/tjh.galenos.2020.2020.0178 |
| ISNAD | Aladag, Elifcan vd. "Comparison of Risk Scoring Systems in HLA-Matched Related Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Cohort Study". Turkish Journal of Hematology 38/2 (2021), 138-144. https://doi.org/10.4274/tjh.galenos.2020.2020.0178 |
