Originally published as JCO Early Release 10.1200/JCO.2006.09.7865 on August 27 2007

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Comorbidity and Disease Status–Based Risk Stratification of Outcomes Among Patients With Acute Myeloid Leukemia or Myelodysplasia Receiving Allogeneic Hematopoietic Cell Transplantation

Mohamed L. Sorror, Brenda M. Sandmaier, Barry E. Storer, Michael B. Maris, Frédéric Baron, David G. Maloney, Bart L. Scott, H. Joachim Deeg, Frederick R. Appelbaum, Rainer Storb

From the Clinical Research Division, Fred Hutchinson Cancer Research Center; and the Departments of Medicine and Biostatistics, University of Washington School of Medicine, Seattle, WA

Address reprint requests to Mohamed Sorror, MD, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D1-100, PO Box 19024, Seattle, WA 98109-1024; e-mail: msorror{at}fhcrc.org

Purpose Retrospective studies have shown similar survival among patients with acute myeloid leukemia (AML) and myelodysplasia (MDS) after nonmyeloablative compared with myeloablative conditioning. Refined risk stratification is required to design prospective trials.

Patients and Methods We stratified outcomes among patients with AML (n = 391) or MDS (n = 186) who received either nonmyeloablative (n = 125) or myeloablative (n = 452) allogeneic hematopoietic cell transplantation (HCT) based on comorbidities, as assessed by a HCT-specific comorbidity index (HCT-CI), as well as disease status. Patients receiving nonmyeloablative conditioning were older, more frequently pretreated, more often received unrelated grafts, and more often had HCT-CI scores of 3 compared with patients who received myeloablative conditioning.

Results Patients with HCT-CI scores of 0 to 2 and either low or high disease risks had probabilities of overall survival at 2 years of 70% and 57% after nonmyeloablative conditioning compared with 78% and 50% after myeloablative conditioning, respectively. Patients with HCT-CI scores of 3 and either low or high disease risks had probabilities of overall survival of 41% and 29% with nonmyeloablative conditioning compared with 45% and 24% with myeloablative regimens, respectively. After adjusting for pretransplantation differences, stratified outcomes were not significantly different among patients receiving nonmyeloablative compared with myeloablative conditioning, with the exception of lessened nonrelapse mortality (hazard ratio, 0.50; P = .05) in the highest risk group.

Conclusion Patients with low comorbidity scores could be candidates for prospective randomized trials comparing nonmyeloablative and myeloablative conditioning regardless of disease status. Additional data are required for patients with low-risk diseases and high comorbidity scores. Novel antitumor agents combined with nonmyeloablative HCT should be explored among patients with high comorbidity scores and advanced disease.

published online ahead of print at www.jco.org on August 27, 2007.

Supported by Grants No. CA78902, CA18029, HL36444, CA15704, and HL088021 from the National Institutes of Health, Department of Health and Human Services, Bethesda, MD. Additional support was provided by awards from the Jose Carreras International Leukemia Foundation, the Josef Steiner Stiftung, the Paros Family, and the Oncology Research Faculty Development Program of the Office of International Affairs of the National Cancer Institute. F.B. is a research associate of the National Fund for Scientific Research Belgium and was supported in part by postdoctoral grants from the Fulbright Commission and from the Centre Anticancéreux près l'Université de Liège.

Presented in part at the American Society of Hematology Meeting, December 3-6, 2005, Atlanta, GA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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