Contributions
Abstract: EP1274
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Several scoring systems have been developed to predict the clinical outcome in hematopoietic stem cell transplantation (HSCT). The score of the European Society for Blood and Marrow Transplantation (EBMT) and the revised Pretransplantation Assessment of Mortality (rPAM) score include clinical characteristics of the patient, donor and disease status. Most recently, the Endothelial Activation and Stress Index (EASIx), a laboratory biomarker-based formula including serum creatinine, lactate dehydrogenase, and platelet count, was developed as a predictor of mortality after allogeneic HSCT (allo-HSCT). Data regarding the comparative performance of these scores are lacking.
Aims
To compare the performance of 3 scoring systems in a cohort of patients (pts) with acute myeloid leukemia (AML) undergoing allo-HSCT.
Methods
Retrospective analysis of 95 adult AML patients (pts) who underwent allo-HSCT between January 2015 and December 2019 in a single institution. EBMT and rPAM scores and EASIx prior to conditioning (EASIx-pre) were calculated for each patient. Using Cox regression, the predictive ability of each score for non-relapse mortality (NRM), relapse free survival (RFS), overall survival (OS), and acute graft versus host disease (aGvHD) was assessed.
Results
The median age at HSCT was 49 years (22-65), and 55% of pts were male. Seventy-five pts (80%) were in first complete remission at the time of allo-HSCT. Fifty-four pts (57%) were treated with myeloablative conditioning (MAC) regimens while the remaining pts received reduced intensity conditioning (RIC). Donors were a matched sibling in 53% of pts, a fully matched unrelated donor in 28%, and a partial matched unrelated donor in 17%. The stem cell source was peripheral blood in the majority of the pts (98%). The incidence of aGvHD was 55%, and the median time to onset of aGvHD was 33 days (8-211). The median OS and RFS for the whole cohort was 26 months and not reached (NR), respectively. NRM rate for the whole cohort was 24%. EASIx-pre predicted OS (HR 1.04; p= 0,021); however, its predictive ability did not remain after adjustment for other variables (age, donor type, conditioning intensity and disease status). RFS, NRM and aGvHD were not predicted by EASIx-pre. Revised PAM score predicted the occurrence of aGvHD (p=0,038); however, this score did not predict OS, RFS and NRM. EBMT score did not predict the assessed outcomes.
Conclusion
In our cohort, EASIx-pre was the only score predicting OS; however, the association between EASIx-pre and OS lost its significance in multivariate analysis, suggesting that EASIx-pre is not an independent predictor of OS. Neither rPAM nor EBMT score could predict survival outcomes. Interestingly, rPAM had a statistically significant association with aGvHD. Our results suggest that new scoring systems relying on biomarkers may improve predictive ability of survival after allo-HSCT for AML.
Keyword(s): Acute myeloid leukemia, Allogeneic hematopoietic stem cell transplant
Abstract: EP1274
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Several scoring systems have been developed to predict the clinical outcome in hematopoietic stem cell transplantation (HSCT). The score of the European Society for Blood and Marrow Transplantation (EBMT) and the revised Pretransplantation Assessment of Mortality (rPAM) score include clinical characteristics of the patient, donor and disease status. Most recently, the Endothelial Activation and Stress Index (EASIx), a laboratory biomarker-based formula including serum creatinine, lactate dehydrogenase, and platelet count, was developed as a predictor of mortality after allogeneic HSCT (allo-HSCT). Data regarding the comparative performance of these scores are lacking.
Aims
To compare the performance of 3 scoring systems in a cohort of patients (pts) with acute myeloid leukemia (AML) undergoing allo-HSCT.
Methods
Retrospective analysis of 95 adult AML patients (pts) who underwent allo-HSCT between January 2015 and December 2019 in a single institution. EBMT and rPAM scores and EASIx prior to conditioning (EASIx-pre) were calculated for each patient. Using Cox regression, the predictive ability of each score for non-relapse mortality (NRM), relapse free survival (RFS), overall survival (OS), and acute graft versus host disease (aGvHD) was assessed.
Results
The median age at HSCT was 49 years (22-65), and 55% of pts were male. Seventy-five pts (80%) were in first complete remission at the time of allo-HSCT. Fifty-four pts (57%) were treated with myeloablative conditioning (MAC) regimens while the remaining pts received reduced intensity conditioning (RIC). Donors were a matched sibling in 53% of pts, a fully matched unrelated donor in 28%, and a partial matched unrelated donor in 17%. The stem cell source was peripheral blood in the majority of the pts (98%). The incidence of aGvHD was 55%, and the median time to onset of aGvHD was 33 days (8-211). The median OS and RFS for the whole cohort was 26 months and not reached (NR), respectively. NRM rate for the whole cohort was 24%. EASIx-pre predicted OS (HR 1.04; p= 0,021); however, its predictive ability did not remain after adjustment for other variables (age, donor type, conditioning intensity and disease status). RFS, NRM and aGvHD were not predicted by EASIx-pre. Revised PAM score predicted the occurrence of aGvHD (p=0,038); however, this score did not predict OS, RFS and NRM. EBMT score did not predict the assessed outcomes.
Conclusion
In our cohort, EASIx-pre was the only score predicting OS; however, the association between EASIx-pre and OS lost its significance in multivariate analysis, suggesting that EASIx-pre is not an independent predictor of OS. Neither rPAM nor EBMT score could predict survival outcomes. Interestingly, rPAM had a statistically significant association with aGvHD. Our results suggest that new scoring systems relying on biomarkers may improve predictive ability of survival after allo-HSCT for AML.
Keyword(s): Acute myeloid leukemia, Allogeneic hematopoietic stem cell transplant