Using Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) to Predict Autologous Transplant-Related Toxicities in Elderly Patients Aged 65 or Older

Background.  An HCT-CI score of 3 demonstrated significant differences in non-relapse mortality (NRM) and overall survival independent from Karnofsky Performance Status (KPS) in allogeneic HCT recipients.  An HCT-CI score of 3 did not predict NRM and survival in multiple myeloma (MM), Hodgkin’s Lymphoma (HL) and non-Hodgkin’s Lymphoma (NHL), but did predict significant differences in the development of grade 3-5 toxicities in NHL patients. 

Purpose.  Use of HCT-CI score to predict grade 3-5 toxicities within 90 days post-autologous HCT in elderly patients.

Method.  Retrospectively utilized an HCT-CI score of 3 to predict grade 3-5 toxicities in autologous HCT patients ≥ 65 years in a single HCT center in 2011.  Outcome variables included pulmonary (pneumonitis or fibrosis), gastrointestinal (diarrhea, nausea or mucositis), neurologic (confusion), renal dysfunction (increased creatinine), hepatic dysfunction (increased ALT/AST), cardiovascular (decreased ejection fraction, and atrial or ventricular arrythmias), fatigue and bone pain.  Grading criteria were based on the National Cancer Institute Common Terminology Criteria Adverse Events version 4.0.

Results.  The sample consisted of 37 autologous HCT recipients a mean of 67.4 years (range of 65-71), including 19 males (51.4%) and 18 females (48.6%) with the following diagnoses MM (13), HL (1) NHL (21) and amyloidosis (2).  At the time of transplant, 59.5% were not in complete remission.  KPS score was ≥ 80% in all patients and ≥ 90% in 33 (89.2%).  One patient expired 19 days post-HCT and two suffered a relapse 55 and 107 days post-HCT, respectively.  Each of these three patients had HCT-CI scores ≥3.  Utilizing HCT-CI criteria, 23 (62.1%) had decreased pulmonary function, 6 (16.2%) had decreased cardiovascular function, 3 (8.1%) had solid tumor history, and 3 (8.1%) had depression or anxiety.

Using an HCT-CI score of 3, 18 patients scoring ≥ 3 developed 44 grade 3-5 toxicities, while 19 patients with a score < 3 developed 20 grade 3-5 toxicities ( p = .002). ANCOVA multivariate analysis demonstrated that an HCT-CI score of 3 can predict the number of grade 3-5 toxicities (p = .044) independently from age, gender, KPS, diagnoses, and pre-transplant disease status.  

Conclusion.  This retrospective study utilizing an HCT-CI score of 3 predicted grade 3-5 toxicity in the first 90 days following HCT in elderly autologous HCT recipients independent of KPS, diagnoses, disease status, age, and gender.  The predictive ability of the HCT-CI is superior to performance status.  Adding HCT-CI to pre-HCT eligibility criteria for elderly patients should be considered.  Use of the HCT-CI may also be utilized as part of pre-HCT counseling and education.