A Risk Score for Mortality after Allogeneic Hematopoietic Cell Transplantation

21 March 2006 | Volume 144 Issue 6 | Pages 407-414

Background: Despite recent advances, mortality rates after allogeneic hematopoietic cell transplantation remain high and cannot be accurately predicted.

Objective: To develop a reliable and valid predictor of all-cause mortality during the first 2 years after allogeneic hematopoietic cell transplantation.

Design: Retrospective cohort.

Setting: Tertiary hematopoietic cell transplantation center.

Patients: Patients (n = 2802) who received a first hematopoietic cell transplant between 1990 and 2002 were assigned to a development group or a validation group.

Measurements: Potential predictor variables were assessed with univariate and multivariable Cox proportional hazards methods to generate a prediction model. The c-statistic was calculated for 5 validation cohorts to assess model performance across early and late time periods and among patients with different diagnoses.

Results: The authors constructed a 50-point Pretransplantation Assessment of Mortality (PAM) score that incorporated 8 pretransplantation clinical variables: patient age, donor type, disease risk, conditioning regimen, FEV₁, carbon monoxide diffusion capacity, serum creatinine level, and serum alanine aminotransferase concentration. The risk for death within 2 years for patients with PAM scores in the highest category was significantly higher than for those with scores in the lowest category. C-statistic values ranged from 0.69 to 0.76 for all validation cohorts.

Limitations: The predictor model was not validated in an external cohort and is only useful for predicting the risk for death within the first 2 years after hematopoietic cell transplantation.

Conclusions: Integrating pretransplantation clinical variables into a single score reliably predicts survival within 2 years after allogeneic hematopoietic cell transplantation. Accurate estimates of the risk for death may be useful in clinical trials and in epidemiologic studies. Such information can also be used to help physicians counsel patients regarding the expected outcomes of this potentially curative procedure.

Editors' Notes Context Many patients who undergo allogeneic hematopoietic cell transplantation have high mortality risks. Contribution In this retrospective cohort study involving 2802 patients with a first hematopoietic cell transplant, investigators devised a 50-point pretransplantation score that predicted risk for death within 2 years. Score variables included age, donor type, disease type, conditioning regimen, FEV1, carbon monoxide diffusion capacity, serum creatinine level, and serum alanine aminotransferase concentration. Cautions We recommend validation of this prognostic score in other populations and settings before routine use. —The Editors

 

Author and Article Information

From the Fred Hutchinson Cancer Research Center and the Veterans Affairs Puget Sound Health Care System, Seattle, Washington.

Grant Support: By American Lung Association of Washington Research grant K23HL69860-01 and the Amy Strelzer Manasevit Research Award from the National Marrow Donor Program. Dr. Au is the recipient of a Veterans Administration Health Services Research and Development Career Development Award.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jason W. Chien, MD, MS, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D5-280, Seattle, WA 98109-1024; e-mail, jchien{at}fhcrc.org.

Current Author Addresses: Dr. Parimon: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D3-245, Seattle, WA 98109-1024.

Dr. Au: Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, 1100 Olive Way, Suite 1400, Seattle WA 98101.

Dr. Martin: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D2-100, Seattle, WA 98109-1024.

Dr. Chien: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Suite D5-280, Seattle, WA 98109-1024.

Author Contributions: Conception and design: T. Parimon, D.H. Au, J.W. Chien.

Analysis and interpretation of the data: T. Parimon, D.H. Au, P.J. Martin, J.W. Chien.

Drafting of the article: T. Parimon, D.H. Au, P.J. Martin, J.W. Chien.

Critical revision of the article for important intellectual content: T. Parimon, D.H. Au, P.J. Martin, J.W. Chien.

Final approval of the article: T. Parimon, D.H. Au, P.J. Martin, J.W. Chien.

Provision of study materials or patients: T. Parimon, P.J. Martin, J.W. Chien.

Statistical expertise: T. Parimon, D.H. Au, J.W. Chien.

Obtaining of funding: J.W. Chien.

Administrative, technical, or logistic support: J.W. Chien.

Collection and assembly of data: T. Parimon, J.W. Chien.

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