TY - JOUR
T1 - Comorbidity-age index
T2 - A clinical measure of biologic age before allogeneic hematopoietic cell transplantation
AU - Sorror, Mohamed L.
AU - Storb, Rainer F.
AU - Sandmaier, Brenda M.
AU - Maziarz, Richard T.
AU - Pulsipher, Michael A.
AU - Maris, Michael B.
AU - Bhatia, Smita
AU - Ostronoff, Fabiana
AU - Deeg, H. Joachim
AU - Syrjala, Karen L.
AU - Estey, Elihu
AU - Maloney, David G.
AU - Appelbaum, Frederick R.
AU - Martin, Paul J.
AU - Storer, Barry E.
N1 - Publisher Copyright:
© 2014 by American Society of Clinical Oncology.
PY - 2014/10/10
Y1 - 2014/10/10
N2 - Patients and Methods: Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age ntervals and a validation set to assess the performance of prognostic models.Purpose: Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cel transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown.Results: In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P =.29), 1.48 (P =.04), 1.75 (P =.004), and 1.84 (P =.005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P <.001) and survival (0.682 v 0.560; P <.001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens.Conclusion: Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.
AB - Patients and Methods: Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age ntervals and a validation set to assess the performance of prognostic models.Purpose: Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cel transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown.Results: In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P =.29), 1.48 (P =.04), 1.75 (P =.004), and 1.84 (P =.005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P <.001) and survival (0.682 v 0.560; P <.001) compared with age, respectively. Patients with comorbidity/age scores of 0 to 2 had comparable mortality risks regardless of conditioning regimens. Patients with scores of 3 to 4 and ≥ 5 had statistically significant higher mortality risks after high-dose versus nonmyeloablative regimens.Conclusion: Age is a poor prognostic factor. The proposed composite measure allows integration of both comorbidities and age into clinical decision making and comparative-effectiveness research of HCT.
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U2 - 10.1200/JCO.2013.53.8157
DO - 10.1200/JCO.2013.53.8157
M3 - Article
C2 - 25154831
AN - SCOPUS:84907533471
SN - 0732-183X
VL - 32
SP - 3249
EP - 3256
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 29
ER -