Disease Risk Comorbidity Index for Patients Receiving Haploidentical Allogeneic Hematopoietic Transplantation

We aimed to develop a disease risk comorbidity index (DRCI) based on disease risk index (DRI) and Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) in patients receiving haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We identified the prognostic factors of disease-free survival (DFS) in a training subset (n = 593), then assigned a weighted score using these factors to the remaining patients (validation subset; n = 296). The multivariable model identified two independent predictors of DFS: DRI and HCT-CI before transplantation. In this scoring system, we assigned a weighted score of 2 to very high-risk DRI, and assigned a weighted score of 1 to high-risk DRI and intermediate- and high-risk HCT-CI (i.e., haplo-DRCI). In the validation cohort, the three-year DFS rate was 65.2% (95% confidence interval (CI), 58.2%-72.2%), 55.8% (95% CI, 44.9%-66.7%), and 32.0% (95% CI, 5.8%-58.2%) for the low-, intermediate-, and high-risk group, respectively (P = 0.005). Haplo-DRCI can also predict DFS in disease-specific subgroups, particularly in acute leukemia patients. Increasing score was also significantly predictive of increased relapse, increased non-relapse mortality (NRM), decreased DFS, and decreased overall survival (OS) in an independent historical cohort (n = 526). These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT. (C) 2020 THE AUTHORS. Published by Elsevier LTD on behalf of Chinese Academy of Engineering and Higher Education Press Limited Company.

Automated summary

The development of Disease Risk Comorbidity Index (DRCI) based on Disease Risk Index (DRI) and Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) allows for effective risk stratification of patients receiving haploidentical hematopoietic stem cell transplantation. The DRCI accurately predicts disease-free survival, particularly in disease-specific subgroups such as acute leukemia patients. This index also shows predictive value for relapse, non-relapse mortality, overall survival, and can aid in identifying patients who will benefit most from the transplantation procedure.