368 Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) Is Predictive of Serious Adverse Events and Overall Survival in Older Allogeneic Transplant Recipients

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Jesse W Keller, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lloyd E Damon, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Lawrence D Kaplan, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Thomas G Martin , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jeffrey L Wolf, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Weiyun Z Ai, MD PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Charalambos Andreadis, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jeffrey M Venstrom, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Catherine C Smith, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Karin ML Gaensler, MD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Jimmy Hwang, PhD , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Rebecca L Olin, MD, MSCE , Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
Background:  The Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) is predictive of non-relapse mortality (NRM) and overall survival (OS) after allogeneic stem cell transplant (SCT). However, the HCT-CI has been less well validated in the older SCT patient population. We hypothesized that the HCT-CI could have less discriminative ability in this population, where multiple comorbidities are common.

Methods: We performed a retrospective study of patients ≥50 years of age who underwent SCT at UCSF, where HCT-CI was recorded prospectively as part of routine clinical care starting in 2007. Outcomes measured included NRM and OS, as well as grade 3-4 non-hematologic adverse events to 100 days post-SCT, duration of hospital stay, and risk of re-hospitalization with the first 100 days. Kaplan Meier methods with log-rank tests were used for analysis of NRM and OS; Student’s t test or chi-square test were used for the remaining outcome measures.

Results:  We identified 59 patients ≥50 years of age with complete HCT-CI data. The median age was 60 years (range 50-74) and 31 (53%) of the patients were male.  Most SCTs were for AML (n=30, 51%) or MDS (n=9, 15%).  SCTs were non-myeloablative in 24 patients (41%) and conditioning was fludarabine/busulfan-based in 53 patients (90%). Median follow up was 22 months.

Twelve patients had HCT-CI score of 0 (20%), 19 had HCT-CI score of 1-2 (32%) and 28 had HCT-CI score ≥3 (47%). High HCT-CI score (≥3) was associated with significantly decreased OS (median OS not reached for HCT-CI 0-2 vs 14 months for HCT-CI ≥3; hazard ratio 2.2, p=0.02). This remained significant in multivariate analysis that included age, KPS, treatment intensity, and the presence or absence of GVHD as covariates (hazard ratio 2.2, p=0.03 for HCT-CI; p=NS for all other covariates). NRM was low in our patient population (12%), and was not significantly different between HCT-CI groups. Grade 3-4 non-hematologic adverse events within the first 100 days after SCT were significantly more common in the higher HCT-CI groups (p=0.02). The most common adverse events were infectious and gastrointestinal. Risk of re-hospitalization within the first 100 days after SCT was not statistically different between groups (17%, 37% and 36% for HCT-CI=0, 1-2 and ≥3 respectively, p=0.45), although patients with HCT-CI=0 did have a trend toward a lower risk than patients with HCT-CI>0 (17% vs 36%, p=0.2). There was no difference in the duration of SCT hospitalization between HCT-CI groups.

Conclusion: Despite a high incidence of multiple comorbidities (HCT-CI score ≥3) in our older cohort, HCT-CI retained its ability to predict OS, specifically by distinguishing those with HCT-CI ≥3 as having a particularly poor prognosis. HCT-CI score ≥3 was a better predictor of OS than age or KPS. We conclude that HCT-CI remains a useful predictor of outcomes in older patients undergoing allogeneic SCT.

See more of: Poster Session 2: Allogeneic Transplants
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