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NEWPORT BEACH, CALIF. – A revised hematopoietic stem cell transplantation comorbidity index developed for adolescents and young adults is useful for predicting nonrelapse mortality in this specific population, according to Brian Friend, MD.
In a retrospective study of 241 patients aged 15-39 years who underwent a first allogeneic hematopoietic stem cell transplant (HCT) between 2005 and 2015 at the University of California, Los Angeles, nonrelapse mortality incidence was particularly high, with rates of 26%, 28%, and 30% at 1, 2, and 3 years, respectively, Dr. Friend, a clinical research fellow at the David Geffen School of Medicine, Los Angeles, reported in a poster at the Acute Leukemia Forum of Hemedicus.
Rather, a history of pulmonary disease – found in 44% of the patients – was the most common comorbidity, and although this was based on pulmonary function tests alone and not necessarily on patient symptoms, it was a surprising finding, he said. It was associated with lower overall survival and with nonrelapse mortality, he added.
A psychosocial component, which took into account factors such as stressors, social support, financial issues, and substance abuse, was also fairly frequent in the patients, but was not necessarily associated with worse outcomes, he noted.
“In multivariable analysis, only a history of prior malignancy (hazard ratio, 2.04) and moderate and severe pulmonary disease (hazard ratios, 1.39 and 1.84, respectively) were associated with a higher incidence of nonrelapse mortality,” he reported.
The existing HCT-CI was developed in adults to help risk-stratify patients undergoing transplant, but adolescents and young adults undergoing HCT tend to have fewer comorbidities compared with older adults, though they still having a significant nonrelapse mortality rate, Dr. Friend said.
“We sought to develop a modified HCT-CI that would be more practical and efficient in predicting outcomes of adolescent and young adult patients,” he wrote.
Data were collected on 15 comorbidities included in the original HCT-CI study, as well as the psychosocial risk factors. The relationship between multiple variables and the incidence of nonrelapse mortality was investigated via the Fine and Gray competing risk model with adjustments for patient- and transplant-specific factors.
A few things were “looked at differently,” he said, explaining, for example, that multiple cardiovascular risk factors were combined into one since they are rare in younger patients.
The study demonstrated that an index including only a few comorbidities important in adolescents and young adults is more predictive in these younger patients vs. adults, suggesting that a simpler model is more practical and useful, Dr. Friend said.
A larger study is planned in conjunction with the Center for International Blood and Marrow Transplant Research (CIBMTR). The researchers for that study will take an in-depth look at this younger population in an effort to develop a novel risk score for them. Other future efforts will focus on developing interventions to target high risk patients – and in particular, modifiable risk factors – with a focus on preventive measures, he said.
Dr. Friend reported having no financial disclosures.
NEWPORT BEACH, CALIF. – A revised hematopoietic stem cell transplantation comorbidity index developed for adolescents and young adults is useful for predicting nonrelapse mortality in this specific population, according to Brian Friend, MD.
In a retrospective study of 241 patients aged 15-39 years who underwent a first allogeneic hematopoietic stem cell transplant (HCT) between 2005 and 2015 at the University of California, Los Angeles, nonrelapse mortality incidence was particularly high, with rates of 26%, 28%, and 30% at 1, 2, and 3 years, respectively, Dr. Friend, a clinical research fellow at the David Geffen School of Medicine, Los Angeles, reported in a poster at the Acute Leukemia Forum of Hemedicus.
Rather, a history of pulmonary disease – found in 44% of the patients – was the most common comorbidity, and although this was based on pulmonary function tests alone and not necessarily on patient symptoms, it was a surprising finding, he said. It was associated with lower overall survival and with nonrelapse mortality, he added.
A psychosocial component, which took into account factors such as stressors, social support, financial issues, and substance abuse, was also fairly frequent in the patients, but was not necessarily associated with worse outcomes, he noted.
“In multivariable analysis, only a history of prior malignancy (hazard ratio, 2.04) and moderate and severe pulmonary disease (hazard ratios, 1.39 and 1.84, respectively) were associated with a higher incidence of nonrelapse mortality,” he reported.
The existing HCT-CI was developed in adults to help risk-stratify patients undergoing transplant, but adolescents and young adults undergoing HCT tend to have fewer comorbidities compared with older adults, though they still having a significant nonrelapse mortality rate, Dr. Friend said.
“We sought to develop a modified HCT-CI that would be more practical and efficient in predicting outcomes of adolescent and young adult patients,” he wrote.
Data were collected on 15 comorbidities included in the original HCT-CI study, as well as the psychosocial risk factors. The relationship between multiple variables and the incidence of nonrelapse mortality was investigated via the Fine and Gray competing risk model with adjustments for patient- and transplant-specific factors.
A few things were “looked at differently,” he said, explaining, for example, that multiple cardiovascular risk factors were combined into one since they are rare in younger patients.
The study demonstrated that an index including only a few comorbidities important in adolescents and young adults is more predictive in these younger patients vs. adults, suggesting that a simpler model is more practical and useful, Dr. Friend said.
A larger study is planned in conjunction with the Center for International Blood and Marrow Transplant Research (CIBMTR). The researchers for that study will take an in-depth look at this younger population in an effort to develop a novel risk score for them. Other future efforts will focus on developing interventions to target high risk patients – and in particular, modifiable risk factors – with a focus on preventive measures, he said.
Dr. Friend reported having no financial disclosures.
NEWPORT BEACH, CALIF. – A revised hematopoietic stem cell transplantation comorbidity index developed for adolescents and young adults is useful for predicting nonrelapse mortality in this specific population, according to Brian Friend, MD.
In a retrospective study of 241 patients aged 15-39 years who underwent a first allogeneic hematopoietic stem cell transplant (HCT) between 2005 and 2015 at the University of California, Los Angeles, nonrelapse mortality incidence was particularly high, with rates of 26%, 28%, and 30% at 1, 2, and 3 years, respectively, Dr. Friend, a clinical research fellow at the David Geffen School of Medicine, Los Angeles, reported in a poster at the Acute Leukemia Forum of Hemedicus.
Rather, a history of pulmonary disease – found in 44% of the patients – was the most common comorbidity, and although this was based on pulmonary function tests alone and not necessarily on patient symptoms, it was a surprising finding, he said. It was associated with lower overall survival and with nonrelapse mortality, he added.
A psychosocial component, which took into account factors such as stressors, social support, financial issues, and substance abuse, was also fairly frequent in the patients, but was not necessarily associated with worse outcomes, he noted.
“In multivariable analysis, only a history of prior malignancy (hazard ratio, 2.04) and moderate and severe pulmonary disease (hazard ratios, 1.39 and 1.84, respectively) were associated with a higher incidence of nonrelapse mortality,” he reported.
The existing HCT-CI was developed in adults to help risk-stratify patients undergoing transplant, but adolescents and young adults undergoing HCT tend to have fewer comorbidities compared with older adults, though they still having a significant nonrelapse mortality rate, Dr. Friend said.
“We sought to develop a modified HCT-CI that would be more practical and efficient in predicting outcomes of adolescent and young adult patients,” he wrote.
Data were collected on 15 comorbidities included in the original HCT-CI study, as well as the psychosocial risk factors. The relationship between multiple variables and the incidence of nonrelapse mortality was investigated via the Fine and Gray competing risk model with adjustments for patient- and transplant-specific factors.
A few things were “looked at differently,” he said, explaining, for example, that multiple cardiovascular risk factors were combined into one since they are rare in younger patients.
The study demonstrated that an index including only a few comorbidities important in adolescents and young adults is more predictive in these younger patients vs. adults, suggesting that a simpler model is more practical and useful, Dr. Friend said.
A larger study is planned in conjunction with the Center for International Blood and Marrow Transplant Research (CIBMTR). The researchers for that study will take an in-depth look at this younger population in an effort to develop a novel risk score for them. Other future efforts will focus on developing interventions to target high risk patients – and in particular, modifiable risk factors – with a focus on preventive measures, he said.
Dr. Friend reported having no financial disclosures.
REPORTING FROM ALF 2018
Key clinical point:
Major finding: As many as 60% of the comorbidities included in the HCT-CI had no significant prevalence in young patients.
Study details: A retrospective study of 241 adolescents and young adults.
Disclosures: Dr. Friend reported having no financial disclosures.
Source: Friend B et al. ALF 2018, Poster Session.