![]() ![]() We first included adult patients (≥18 yr) who underwent alloSCT between January 2002 and December 2018 in the KNHIS database using the procedure codes V073, X5061, and/or X5063. We were also interested in the development of a prognostic scoring system based on identified individual comorbidities, followed by external validation of the developed system using an independent database of the development cohort from the KNHIS data.ĭata for the development cohort were extracted from the KNHIS database. These strengths enable research on a nationwide cohort with the endpoint of identifying personal comorbidities related to patient prognosis after alloSCT.Īccordingly, this study aimed to verify whether well-known patient comorbidity-related prognostic factors, including age, sex, previous non-hematologic malignancy, hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD), cerebrovascular or cardiovascular disease (CVA), anxiety disorder, and depression, have prognostic impacts on outcomes of alloSCT using KNHIS data. The KNHIS database contains universal medical claims and mortality for the entire Korean population and has been used in various epidemiological research studies on hematologic diseases, as described in detail elsewhere. In Korea, the Korean National Health Insurance Service (KNHIS) program is a mandatory public health insurance system that covers approximately 98% of the overall Korean population. Furthermore, the prognostic impact of commonly emphasized variables among the aforementioned comorbidity indices, such as diabetes, hypertension, cerebrovascular disease, pulmonary dysfunction, and prior non-hematologic malignancy, has not yet been validated in a Korean nationwide cohort. Nevertheless, these indices were not established in a nationwide cohort of patients with acute leukemia. These indices also provide a well-defined risk stratification for mortality. In this regard, various models, including the hematopoietic cell transplantation-specific comorbidity index (HCT-CI), comorbidity-age index, and Charlson comorbidity index, have been used for pre-transplant risk stratification prior to alloSCT based on the patient’s comorbidities. In addition to emerging biological factors (such as adverse cytogenetics, failure to achieve minimal residual disease, and intolerance to chemotherapeutic toxicities), the comorbidity of individuals could have tremendous impacts on the prognosis of alloSCT. Thus, a precise risk-adapted approach remains an unmet need in clinical practice. However, a low overall survival (OS) related to relapse or treatment-related mortality is an important obstacle that compromises the efficacy of alloSCT. Keywords Comorbidity, Allogeneic, Transplantation, Stem cell, Acute leukemia, ScoreĪlthough novel therapies have recently been introduced, allogeneic hematopoietic stem cell transplantation (alloSCT) is still regarded as the only curative modality for acute leukemia. The newly developed predictive scoring system could be a simple and reliable tool helping clinicians to assess risk of alloSCT in adults with acute leukemia. Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715. The developed scoring system yielded discriminatively different 1-year OS rates and 1-year incidence of non-relapse mortality according to the risk group ( P =0.085 and P=0.018, respectively). The 1-year OS rates were discriminatively estimated at 73.5%, 66.2%, 61.9%, and 50.9% in the low-risk, intermediate-risk, high-risk, and very high-risk groups in the development cohort, respectively ( P <0.001). Subsequently, a new comorbidity scoring system was developed, and risk groups were created, which included the low-risk (score ≤0.17), intermediate-risk (0.17< score ≤0.4), high-risk (0.4< score ≤0.55), and very high-risk (score >0.55) groups. ![]() In the development cohort, advanced age, male sex, and comorbidities such as previous non-hematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. A retrospective cohort comprising 313 consecutive adults with acute leukemia who underwent alloSCT between January 2019 and April 2020 was analyzed as the validation cohort. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS).Ī Korean nationwide cohort of 3,809 adults with acute leukemia treated with alloSCT between January 2002 and December 2018 was analyzed as the development cohort. Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. ![]()
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