Predominant low Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) score in a Mexican referral center: a selection bias caused by limited-resources?

Leon-Rodriguez, Eucario; Rivera-Franco, Monica Magdalena; Lastra-German, Isabel Katherine

doi:10.1016/j.htct.2020.03.004

Acessibilidade / Reportar erro

Brasil

Hematology, Transfusion and Cell Therapy

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original article • Hematol., Transfus. Cell Ther. 43 (03) • Jul-Sep 2021 • https://doi.org/10.1016/j.htct.2020.03.004 copy

Predominant low Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) score in a Mexican referral center: a selection bias caused by limited-resources?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

To date, many studies have validated the Hematopoietic Cell Transplantation Specific Comorbidity Index (HCT-CI) scoring system in allogeneic hematopoietic stem cell transplantation (allo-HSCT), but studies from developing countries remain scarce.

Objective:

The aim of this study was to evaluate and categorize Mexican patients using the HCT-CI at a referral center.

Methods:

One hundred and nineteen consecutive patients undergoing allo-HSCT at the National Institute of Medical Sciences and Nutrition in Mexico City were included. Patients were classified according to the HCT-CI scores.

Results:

The median age was 31 years and most were males (56%). Most patients had hematological malignancies (73%) and a low HCT-CI score (72%). The non-relapse mortality and survival were predicted according to the score.

Conclusions:

This is one of the few studies to evaluate the HCT-CI in adults with HLA-matched donors in a developing country and our findings suggest that the high percentage of patients with a low HCT-CI scores, contrary to international reports, could be explained by different comorbidities and demographics, but mainly due to stricter filters applied to HSCT candidates and consequently, a potential selection bias caused by limited resources.

Keywords:
HCT-CI; Allogeneic; Hematopoietic stem cell; transplantation; Non-relapse mortality; Overall survival; Developing country

Characteristic	n (%)
Patient gender
Male	66 (56)
Female	53 (44)
Median age (range)	31 (16−63)
Underlying disease AA	24 (19)
ALL	28 (23)
1^◦CR	19
≥2◦CR	9
AML	14 (12)
1^◦CR	4
≥ 2^◦CR	10
CML	15 (13)
HL	3 (3)
NHL	3 (3)
MDS	21 (18)
Hypoplastic	11
Refractory anemia	4
Multilineage dysplasia	5
CMML	1
Others	11 (9)
ADLD	1
PNH	4
EPP	1
MPN	1
MF	2
FA	27
Disease Risk Index ¹⁹19 Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME, et al. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 2014;123(23):3664–71.
Low	15 (13)
Intermediate	52 (44)
High	18 (15)
Very High	2 (2)
Not applicable (benign diseases)	32 (27)
HCT-CI score ¹1 Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912–9.
Low	86 (72)
Intermediate	29 (25)
High	4 (3)
Flexible HCT-CI ¹⁵15 Nakaya A, Mori T, Tanaka M, Tomita N, Nakaseko C, Yano S, et al. Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A prospective multicenter validation study of the Kanto Study Group for cell therapy. Biol Blood Marrow Transplant. 2014;20(10):1553–9.
Low	117 (98)
High	2 (2)
Year
<2012	63 (53)
2012–2018	56 (47)
HLA matched donor Related	112 (94)
Unrelated (8/8 matched)	7 (6)
Gender disparity
Yes	52 (43)
No	66 (56)
Unknown	1 (1)

HCT-CI Comorbidity	Score	n (%)
Arrhythmia	1	0
Heart	1	1 (1)
Cerebrovascular disease	1	1 (1)
Diabetes	1	8 (7)
Hepatic disease (mild)	1	5 (4)
Infection	1	5 (4)
Inflammatory bowel disease	1	1 (1)
Obesity	1	0
Depression	1	16 (13)
Peptic ulcer	2	0
Pulmonary disease (moderate)	2	1 (1)
Renal failure (moderate/severe)	2	1 (1)
Rheumatologic disorder	2	1 (1)
Heart valve disease	3	0
Hepatic disease (moderate/severe)	3	1 (1)
Prior solid tumor	3	2 (2)
Pulmonary disease (severe)	3	0

Characteristic	Low (n = 86) n (%)	Intermediate (n = 29) n (%)	High (n = 4) n (%)	p
Disease risk index ¹⁹19 Armand P, Kim HT, Logan BR, Wang Z, Alyea EP, Kalaycio ME, et al. Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 2014;123(23):3664–71.
Low	11 (13)	4 (14)	0	0.3
Intermediate	37 (43)	12 (41)	3 (75)
High/very high	14 (16)	6 (21)	0
Not applicable (benign diseases)	24 (28)	7 (24)	1 (25)
Conditioning regimens
MAC	65 (76)	23 (77)	3 (75)	0.9
RIC	21 (24)	6 (23)	1 (25)
HSC source
G-BM	52 (61)	12 (41)	4 (100)	0.2
SS-BM	18 (21)	9 (31)	0
PBSC	14 (16)	8 (28)	0
CB	2 (2)	0	0
Type of disease
Malignancies	62 (72)	22 (76)	3 (75)	0.9
Non-malignant	24 (28)	7 (24)	1 (25)
Median CD34+ cell × 10⁶6 Sperr WR, Wimazal F, Kundi M, Baumgartner C, Nosslinger T, Makrai A, et al. Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group. Ann Oncol. 2010;21:114–9./kg (range)	1.87 (0.86–8.26)	2.4 (0.65–7.30)	2.08 (1.70–3.10)	0.2
Median engraftment days (range)
Neutrophils	20 (11–43)	20 (9–31)	27.5 (25–40)	0.02
Platelets	15 (5–78)	17 (8–45)	22 (20–29)	0.2
Median hospitalization days (range)	34 (19–128)	35 (12–112)	52 (41–61)	0.03
Toxicities
Grades I–II	38 (44)	13 (48)	2 (50)	0.3
Grades III–IV	39 (46)	10 (32)	1 (25)
None	9 (10)	6 (20)	1 (25)
Infections
Neutropenic fever	30 (35)	16 (58)	2 (50)	0.5
Other	40 (46)	9 (29)	2 (50)
None	16 (19)	4 (13)	0
GVHD
Acute	20 (24)	9 (35)	0	0.6
Grades I–II	10	6	0	0.9
Grades III–IV	10	3	0
Chronic	32 (41)	9 (41)	2 (67)	0.5
Limited	19	8	2	0.5
Extensive	13	1	0
NRM
30-day	3 (3)	3 (10)	0	0.3
100-day	7 (8)	4 (14)	1 (25)	0.7
1-year	10 (12)	6 (21)	1 (25)	0.02
2-year	11 (13)	6 (21)	3 (75)	0.07
Relapse (5 years)	23 (26)	12 (41)	1 (25)	0.3
5-year Survival
OS	62 %	46 %	0	0.01
DFS	66 %	48 %	75 %	0.2

Study	HCT-CI scores
Study	Low	Intermediate	High
Sorror et al.¹1 Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912–9.	38%	34%	28%
Majhail et al.¹¹11 Majhail NS, Brunstein CG, McAvoy S, DeFor TE, Al-Hazzouri A, Setubal D, et al. Does the hematopoietic cell transplantation specific comorbidity index predict transplant outcomes? A validation study in a large cohort of umbilical cord blood and matched related donor transplants. Biol Blood Marrow Transplant. 2008;14:985–92.	16%	32%	52%
Sperr et al.⁶6 Sperr WR, Wimazal F, Kundi M, Baumgartner C, Nosslinger T, Makrai A, et al. Comorbidity as prognostic variable in MDS: comparative evaluation of the HCT-CI and CCI in a core dataset of 419 patients of the Austrian MDS Study Group. Ann Oncol. 2010;21:114–9.	53%	27%	20%
Raimondi et al.⁷7 Raimondi R, Tosetto A, Oneto R, Cavazzina R, Rodeghiero F, Bacigalupo A, et al. Validation of the hematopoietic cell transplantation-specific comorbidity index: a prospective, multicenter GITMO study. Blood. 2012;120:1327–33.	58%	23%	19%
Mo et al.²⁶26 Mo XD, Xu LP, Liu DH, Zhang XH, Chen H, Chen YH, et al. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) is an outcome predictor for partially matched related donor transplantation. Am J Hematol. 2013;88(6):497–502.	31%	31%	38%
Nakaya et al.¹⁵15 Nakaya A, Mori T, Tanaka M, Tomita N, Nakaseko C, Yano S, et al. Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A prospective multicenter validation study of the Kanto Study Group for cell therapy. Biol Blood Marrow Transplant. 2014;20(10):1553–9.	32%	30%	38%
Sorror et al.²²22 Sorror ML, Logan BR, Zhu X, Douglas Rizzo J, Cooke KR, McCarthy PL, et al. Prospective validation of the predictive power of the hematopoietic cell transplantation comorbidity index: a CIBMTR® study. Biol Blood Marrow Transplant. 2015;21(8):1479–87.	48%	26%	26%
Teixera et al.²⁹29 Teixeira GM, Bittencourt H, de Macedo AV, Martinho GH, Colosimo EA, Rezende SM. Assessing the influence of different comorbidities indexes on the outcomes of allogeneic hematopoietic stem cell transplantation in a developing country. PLoS One. 2015;10(9):e0137390.	63%	29%	8%
Figueroa-Turienzo et al.²⁵25 Figueroa-Turienzo CM, Cernadas C, Roizen M, Pizzi S, Satciuk R. Validation of the hematopoietic cell transplantation-specific comorbidity index in a retrospective cohort of children and adolescents who received an allogeneic transplantation in Argentina. Arch Argent Pediatr. 2016;114(4):337–42.	46%	41%	13%
Törlén et al.²³23 Törlén J, Remberger M, Le Blanc K, Ljungman P, Mattsson J. Impact of pretransplantation indices in hematopoietic stem cell transplantation: knowledge of center-specific outcome data is pivotal before making index-based decisions. Biol Blood Marrow Transplant. 2017;23(4):677–83.	37%	28%	35%
Current study	72%	25%	3%

Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
E-mail: htct@abhh.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author at: Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Belisario Dominguez Seccion XVI, Tlalpan, Mexico City 14080, Mexico. E-mail address: eucario.leonr@incmnsz.mx (E. Leon-Rodriguez).