Interaction of Age and Comorbidities and Their Impacts on Hematopoietic Cell Transplantation (HCT) Outcomes
Interaction of Age and Comorbidities and Their Impacts on Hematopoietic Cell Transplantation (HCT) Outcomes
复制标题
年龄和合并症的相互作用及其对造血细胞移植 (HCT) 结果的影响
DOI：
10.1182/blood.v118.21.665.665
复制
发表时间：
2011
期刊：
影响因子：
20.3
通讯作者：
M. Sorror
中科院分区：
文献类型：
--
作者：
F. Ostronoff;B. Storer;R. Storb;S. Bhatia;R. Maziarz;M. Pulsipher;M. Maris;H. Deeg;P. Martin;F. Appelbaum;D. Maloney;B. Sandmaier;M. Sorror
从历史上看，年龄一直是同种异体HCT的主要患者（pt）特异性决策因素。HCT合并症指数（CI）被开发用于捕获移植前合并症。该指数预测非复发死亡率（NRM），并彻底改变了同种异体HCT的结果分析。日历年龄是否在结果预测中为HCT-CI增加了额外的信息水平尚不清楚。在这里，我们研究了1)HCT-CI预测不同年龄组结果的效果如何，2)年龄是否可以纳入HCT-CI。在2000年1月至2006年12月期间，来自5个合作机构的3033名连续接受同种异体HCT治疗的患者的数据来自hla匹配的相关或非相关供体。所有数据均由一名研究者收集，该研究者对患者的最终结果不知情，以确保合并症编码的一致性。中位年龄为45岁（范围0.1-74.5）。总体而言，年龄增加与HCT-CI评分增加之间存在弱相关性（r=0.26）。患者随机分为训练组（n=1853）和验证组（n=1180）。在训练集中，HCT-CI预测NRM的累积发病率增加和总生存率（OS）的恶化在5个不同年龄组中一致（表1）。51%的患者未进行肺功能检查p使用比例风险模型来估计NRM和OS与不同年龄间隔和其他协变量（包括HCT-CI评分）相关的风险比（hr）（表2）。在该模型中，不同年龄组HCT-CI评分1-2和≥3的hr同质性检验均未被NRM（分别为p= 0.66和p= 0.86）或OS（分别为p= 0.76和p= 0.24）拒绝。与其他协变量相比，HCT-CI评分的增加与NRM的最高hr相关。40 - 50岁、50-60岁和60岁年龄组的患者NRM的hr范围为1.48-1.84，而40岁年龄组的患者HCT-CI评分为1分。在验证集中，尽管我们继续观察到NRM的hr随着年龄的增加而增加，但当年龄加入到HCT-CI时，NRM的c-统计数据只有轻微的改善（0.66对0.68）。这些结果表明，HCT- ci对所有年龄组的预后预测都是有效的，在考虑合共病的模型中，年龄本身对HCT预后预测的影响相对较小。年龄bb0 - 40岁的影响相当于单一合并症，权重为1，因此在使用HCT-CI/年龄综合指数时应给予1分。披露：无相关利益冲突需要申报。
Abstract 665 Historically, age has been the main patient (pt)-specific decision-making factor for allogeneic HCT. The HCT comorbidity index (CI) was developed to capture pretransplant comorbidities. The index predicts non-relapse mortality (NRM) and has revolutionized outcome analysis for allogeneic HCT. Whether calendar age adds additional level of information to the HCT-CI in outcome prediction is unknown. Here, we investigated 1) how well the HCT-CI predicts outcomes across different age groups and 2) whether age could be incorporated into the HCT-CI. Data from 3033 consecutive pts treated with allogeneic HCT between January 2000 and December 2006 from HLA-matched related or unrelated donors at five collaborating institutions were used for this study. All data were collected by a single investigator, who was blinded from the final outcomes of pts, to ensure consistent comorbidity coding. Median age was 45 (range 0.1–74.5) years. Overall, there was a weak correlation between increasing age and increasing HCT-CI scores (r=0.26). Pts were randomly divided into training (n=1853) and validation (n=1180) sets. In the training set, the HCT-CI predicted increased cumulative incidence rates of NRM and worsening of overall survival (OS) rates consistently in the 5 separate age groups (Table 1). Pulmonary function tests were not performed in 51% of pts p A proportional hazards model was used to estimate the hazard ratios (HRs) for NRM and OS associated with different age intervals and other covariates, including the HCT-CI scores (Table 2). In this model, tests of homogeneity of HRs associated with HCT-CI scores of 1–2 and ≥3 across age groups were not rejected for either NRM ( p =0.66 and p =0.86, respectively) or OS ( p= 0.76 and p =0.24, respectively). Increasing HCT-CI scores were associated with the highest HRs for NRM compared to other covariates. Pts in age groups 40–50, 50–60, and >60 years had HRs for NRM ranging between 1.48–1.84 compared to pts 40 years was assigned a score of 1 to be added to the HCT-CI scores. In the validation set, although we continued to observe increases in HRs for NRM with increasing age, only minor improvement in c-statistics for NRM (0.66 versus 0.68) was detected when age was added to the HCT-CI. These results indicate that the HCT-CI is valid for outcome prediction across all age groups and that age per se has a relatively minor impact on HCT outcome prediction in models that account for comorbidities. Age >40 years had an impact equivalent to a single comorbidity with a weight of 1, and therefore should be assigned a score of 1 when using the HCT-CI/Age composite index. Disclosures: No relevant conflicts of interest to declare.