Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission
Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission
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DOI：
10.1038/leu.2014.164
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发表时间：
2015-01-01
期刊：
影响因子：
11.4
通讯作者：
Mohty, M.
中科院分区：
文献类型：
--
作者：
Versluis, J.;Labopin, M.;Mohty, M.
同种异体造血干细胞移植（alloHSCT）术后非复发死亡率（NRM）可以通过不同参数组成的造血细胞移植共病指数（HCT-CI）和欧洲血液和骨髓移植组织（EBMT）评分来预测。我们开始整合首次完全缓解（CR1）的急性髓性白血病（AML）患者接受低强度调节（RIC）同种异体造血移植的两个评分参数。通过多变量分析评估812例患者的HCT-CI和ebmt评分（加上患者和供体巨细胞病毒血清学）的所有参数，并在2年时进行终点NRM。随后，根据风险比>1.2选取16个参数，合并成一个新的评分，并通过bootstrapping进行内部验证。HCT-CI和ebmt评分均显示出相对较弱的预测价值，而综合评分允许识别三个明显不同的风险组，2年NRM估计为8 +/- 2%（低风险），17 +/- 2%（中风险）和38 +/- 4%（高风险），这也转化为对总生存的预测。总的来说，整合来自HCT-CI和ebmt评分的最主要参数，可以开发一个简单而稳健的综合评分，改善了AML患者在CR1中进行RIC同种异体造血移植的NRM预测。
Non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (alloHSCT) can be predicted by the hematopoietic cell transplantation comorbidity index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score, which are composed of different parameters. We set out to integrate the parameters of both scores in patients with acute myeloid leukemia (AML) in first complete remission (CR1) receiving reduced intensity conditioning (RIC) alloHSCT. All parameters from the HCT-CI and the EBMT-score with the addition of patient and donor cytomegalovirus serology were evaluated in 812 patients by multivariable analysis with end-point NRM at 2 years. Subsequently, 16 parameters were selected based on hazard ratio >1.2, and were incorporated into a novel score, which was further internally validated by bootstrapping. Both the HCT-CI and the EBMT-score showed relatively weak predictive value, whereas the integrated score allowed to identify three clearly distinct risk groups with 2-year NRM estimates of 8 +/- 2% (low-risk), 17 +/- 2% (intermediate-risk) and 38 +/- 4% (high-risk), which also translated in prediction of overall survival. Collectively, integration of the most dominant parameters from the HCT-CI and the EBMT-score allowed to develop a simple and robust, integrated score with improved prediction of NRM for AML patients proceeding to RIC alloHSCT in CR1.