预测自体移植后的死亡率:一种新的风险评分方法的发展

IF 4.3 Q1 Medicine
Mariano Berro , Saurabh Chhabra , José Luis Piñana , Jorge Arbelbide , Maria M. Rivas , Ana Lisa Basquiera , Adriana Vitriu , Alejandro Requejo , Vera Milovic , Sebastian Yantorno , Gonzalo Bentolila , Juan Jose Garcia , Martin Castro , Silvina Palmer , Martin Saslavsky , Patricio Duarte , Amalia Cerutti , Gustavo Jarchum , Matias Tisi Baña , Bicky Thapa , Gustavo Kusminsky
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引用次数: 7

摘要

已有一些研究试图预测自体干细胞移植(ASCT)后的死亡率,如造血细胞移植合并症指数(HCT-CI),该指标用于异体干细胞移植,并对ASCT进行了验证,但在ASCT合并合并症和其他临床特征的情况下,没有综合评分。我们的目的是描述一个结合合并症和其他临床因素的综合评分,并分析该评分对ASCT后非复发死亡率(NRM)、总生存期(OS)和早期发病率终点(机械通气、休克或透析)的影响。对于培训队列,我们回顾性回顾了阿根廷(2002年10月至2017年6月)接受多发性骨髓瘤或淋巴瘤ASCT的2068名成年患者的数据。对于验证队列,我们分析了2012年1月至2018年12月在威斯康辛医学院和西班牙干细胞移植组(Grupo Español de Trasplante hematopoy2013.com (GETH))进行的2168例asct。我们首先对NRM进行了多变量分析,以选择和分配评分中包含的危险因素(男性患者,年龄55 - 64岁,≥65岁,HCT-CI≥3,霍奇金淋巴瘤和非霍奇金淋巴瘤)。NRM的风险比随着得分成比例地增加。患者分为低危(LR),评分为0 ~ 1分(686.33%),中危(IR),评分为2 ~ 3分(1109,53%),高危(HR),评分为4分(198,10%),极高危(VHR),评分≥5分(75.4%)。该评分与所有早期发病率终点的进行性增加相关。此外,该评分与早期NRM(第100天:1.5% vs . 2.4% vs . 7.6% vs . 17.6%)以及长期(1至3年;分别是1.8% - 2.3% 3.8% - 4.9% 11.7% - 14.5% 25.0% - 27.4%;术中;0.0001)和OS(1 - 5年;94%对73% 89%对75% 76%对47% 65%对52%P & lt;。)。该评分在独立队列(N = 2168)中得到验证,并与早期和晚期事件显著相关。总之,我们在2000多名自体移植患者的2个大队列中开发并验证了一种预测NRM和OS的新评分。该工具可用于定制调理方案或确定移植计划决策的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predicting Mortality after Autologous Transplant: Development of a Novel Risk Score

There have been several efforts to predict mortality after autologous stem cell transplantation (ASCT), such as the hematopoietic cell transplant-comorbidity index (HCT-CI), described for allogeneic stem cell transplantation and validated for ASCT, but there is no composite score in the setting of ASCT combining comorbidities with other clinical characteristics. Our aim is to describe a comprehensive score combining comorbidities with other clinical factors and to analyze the impact of this score on nonrelapse mortality (NRM), overall survival (OS), and early morbidity endpoints (mechanical ventilation, shock or dialysis) after ASCT. For the training cohort, we retrospectively reviewed data of 2068 adult patients who received an ASCT in Argentina (October 2002 to June 2017) for multiple myeloma or lymphoma. For the validation cohort, we analyzed 2168 ASCTs performed in the Medical College of Wisconsin and Spanish stem cell transplant group (Grupo Español de Trasplante Hematopoyético (GETH)) (January 2012 to December 2018). We first performed a multivariate analysis for NRM in order to select and assign weight to the risk factors included in the score (male patients, aged 55 to 64 and ≥65 years, HCT-CI ≥3, Hodgkin lymphoma and non-Hodgkin lymphoma). The hazard ratio for NRM increased proportionally with the score. Patients were grouped as low risk (LR) with a score of 0 to 1 (686, 33%), intermediate risk (IR) with a score of 2 to 3 (1109, 53%), high risk (HR) with a score of 4 (198, 10%), and very high risk (VHR) with a score of ≥5 (75, 4%). The score was associated with a progressive increase in all the early morbidity endpoints. Moreover, the score was significantly associated with early NRM (day 100: 1.5% versus 2.4% versus 7.6% versus 17.6%) as well as long term (1 to 3 years; 1.8% to 2.3% versus 3.8% to 4.9% versus 11.7% to 14.5% versus 25.0% to 27.4%, respectively; P< .0001) and OS (1 to 5 years; 94% to 73% versus 89% to 75% versus 76% to 47% versus 65% to 52% respectively; P < .0001). The score was validated in an independent cohort (N = 2168) and was significantly associated with early and late events. In conclusion, we developed and validated a novel score predicting NRM and OS in 2 large cohorts of more than 2000 autologous transplant patients. This tool can be useful for tailoring conditioning regimens or defining risk for transplant program decision making.

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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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