Pre-transplant comorbidity burden and post-transplant chronic graft-versus-host disease

Br J Haematol. 2015 Nov;171(3):411-6. doi: 10.1111/bjh.13591. Epub 2015 Jul 20.

Abstract

The Haematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) was designed as a predictor of non-relapse mortality after HCT. Chronic graft-versus-host disease (GVHD) contributes to mortality after HCT. Here, we investigated whether the HCT-CI could predict development of chronic GVHD or post-chronic GVHD mortality. We retrospectively analysed data from 2909 patients treated with allogeneic HCT for malignant and non-malignant haematological conditions at four institutions. In Cox regression models adjusted for potential confounders, increasing HCT-CI was not statistically significantly associated with the development of chronic GVHD [hazard ratio (HR) = 1·02, P = 0·34]. Yet, the index was associated with an increased risk of non-relapse mortality (HR = 1·29, P < 0·0001) as well as overall mortality (HR = 1·25, P < 0·001) following the development of chronic GVHD. The association between HCT-CI and post-chronic GVHD mortality was similar regardless of donor type or stem cell source. HCT-CI scores could be incorporated in the design of clinical trials for treatment of chronic GVHD.

Keywords: Haematopoietic Cell Transplantation-Comorbidity Index; graft-versus-host disease; haematopoietic stem cells; non-relapse mortality after HCT; transplantation.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Allografts
  • Child
  • Child, Preschool
  • Chronic Disease
  • Comorbidity
  • Disease-Free Survival
  • Female
  • Graft vs Host Disease / etiology
  • Graft vs Host Disease / mortality*
  • Graft vs Host Disease / pathology
  • Hematologic Diseases / mortality*
  • Hematologic Diseases / pathology
  • Hematologic Diseases / therapy*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Risk Factors
  • Survival Rate
  • Tissue Donors*