The Impact of Comorbidity, Performance Status and Insurance Coverage in Patients Undergoing Myeloablative Allogeneic Transplant

The Impact of Comorbidity and Performance Status in Patients Undergoing Myeloablative Transplant Most diseases treated by hematopoietic stem cell transplant (HSCT) occur in individuals greater than 45 years of age. With the aging population and the advent of new transplant regimens, the incidence of comorbidities in the transplant patient population is increasing. Intensive chemotherapy causes increased non-relapse mortality in this population. The primary objective of this study is to determine if an association exists between non-relapse mortality and calculated comorbidity index (CMI) and Karnofsky performance (KPS) scores in patients undergoing myeloablative preparative regimens for HSCT. Secondary objectives were to assess the impact of insurance on overall survival, specifically with high CMI cases. We conducted a cross-sectional chart review of HSCT patients at the Oklahoma tertiary referral hospital. Eligible patients included adults ages 18-99 who received a myeloablative allogeneic HSCT between 2007 and 2011. The age range in our population ranged from 18-59. Data was collected from inpatient and outpatient charts in a de-identified manner. This study was approved by the institutional review board of the University of Oklahoma Health Sciences Center. Patient comorbidity index scores were calculated within 30 days of transplant using the QxMD Hematopoietic Cell Transplantation-Specific Index (HCT-CI) calculator. Karnofsky Performance Status was determined by a physician during pre-transplant assessment. Additional pre-transplant data collected included: gender, age at transplant, date of transplant, donor type, donor source, preparative method, specific preparative regimen, disease status at the time of transplant, disease type, and insurance status. Post-transplant data collected included: survival at 100 days, 1 year, and 2 years post-transplant, cause of death, presence of graft-versus-host disease (GVHD), type of GVHD, organ affected by GVHD, and documented infections. Our results indicated that higher CMI scores were significantly associated with increased non-relapse mortality in patients undergoing myeloablative transplant preparative regimens (p < 0.001). Lower KPS scores were also significantly associated with poor survival (p < 0.001). Insurance was not significantly associated with non-relapse mortality (p > 0.05). Finally, 39% of all patient deaths were attributed to disease, 20% of patient deaths were attributed to non-relapse mortality, while 41% of patients survived.