463 Association of Comorbidity Scoring with Outcome in Patients with Chronic Graft Versus Host Disease

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
William A Wood, MD, MPH , Department of Medicine, Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Xiaoyu Chai, MS , Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
Daniel J. Weisdorf, MD , Masonic Cancer Center, University of Minnesota, Minneapolis, MN
Paul J Martin, MD , Fred Hutchinson Cancer Research Center, Seattle, WA
Corey Cutler, MD MPH FRCP(C) , Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
Yoshihiro Inamoto, MD, PhD , Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Daniel Wolff, MD , Department of Hematology and Clinical Oncology, University of Regensburg, Regensburg, Germany
Steven Z. Pavletic, MD , NCI Experimental Transplantation and Immunology Branch, National Institute of Health NIH, Bethesda, MD
Joseph Pidala, MD, MS , Hematology/Oncology, Moffitt Cancer Center, Tampa, FL
Jeanne Palmer, MD , Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
Mukta Arora, MD MS , Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN
Sally Arai, MD , Stanford University, Stanford, CA
Madan H. Jagasia, MD , Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
Barry Storer, PhD , Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Stephanie J. Lee, MD, MPH , Clinical Transplant Research, Fred Hutchinson Cancer Research Center, Seattle, WA
Sandra Mitchell, PhD, CRNP , Research and Practice Development Service, National Institutes of Health, Rockville, MD
Background: Chronic graft versus host disease (cGVHD) is associated with mortality, disability and impaired quality of life. The importance of comorbidities in patients with cGVHD has not been reported, though this information could be important for prognostication and tailoring of treatment. Patients and Methods: We studied 239 patients > 2 years of age (median 53y, range 11-79) diagnosed with cGVHD by the NIH consensus criteria and requiring systemic immunosuppressive therapy, enrolled in the cGVHD Consortium at the Fred Hutchinson Cancer Research Center (FHCRC). Both incident and prevalent cases were included. The Functional Comorbidity Index (FCI) and the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) were calculated for all patients at the time of transplant and cGVHD cohort enrollment. Global cGVHD severity by NIH criteria was mild or less in 8%, moderate in 54%, and severe in 38% of the patients. Median follow-up of survivors was 32 months (range 0.6-55.0). Univariate and multivariate Cox regression models were constructed, adjusting for all known and available risk factors including NIH global severity score at enrollment. Results: The mean FCI score at the time of transplantation was 1.8 (range 0-8), increasing to 2.7 (range 0-7) at the time of cGVHD cohort enrollment (p<0.001). The mean HCT-CI score at the time of transplantation was 2.6 (range 0-8), increasing to 3.7 (range 0-12) at the time of cohort enrollment (p<0.001).  Higher FCI scores did not predict risk of overall or non-relapse mortality. At enrollment, in multivariate analyses adjusted for clinical covariates, a statistically significant interaction of the HCT-CI with platelet count was observed (p=0.003). Higher HCT-CI scores at enrollment were associated with an increased risk of overall mortality when the platelet count was < 100,000/ml (HR 2.01 for 1-pt increase in HCT-CI: 1.20-3.35, p=0.01), but not when > 100,000/ml (HR 1.05: 0.90-1.22, p=0.53). For non-relapse mortality, higher HCT-CI scores at the time of cGVHD cohort enrollment were also predictive (HR 1.21:1.04-1.42, p=0.01). Because of overlap between the HCT-CI and the NIH cGVHD severity scale in the scoring of liver (correlation=0.61) and lung (correlation=0.61) dysfunction, a version of the HCT-CI that excluded liver and lung variables was tested and remained significantly associated with overall survival in univariate analysis (HR 1.19, p=0.02). Removing the NIH cGVHD global score from the model did not enhance the significance of the HCT-CI (HR 1.16, p=0.02). Conclusions: A higher comorbidity burden by the HCT-CI at the time of enrollment into a cGVHD cohort is associated with an increased risk for mortality. We recommend further studies of comorbidity scoring in patients with cGVHD and urge further investigations that could lead to a mechanistic understanding of physiologic vulnerability in patients with cGVHD.
See more of: Poster Session 2: GVH/GVL
See more of: Contributed Abstracts
<< Previous Abstract | Next Abstract >>