Development and validation of a comorbidity index for predicting survival outcomes after allogeneic stem cell transplantation in adult patients with acute leukemia: a Korean nationwide cohort study
Sung-Soo Park1, Hee-Je Kim1,2, Tong Yoon Kim1, Joon yeop Lee1, Jong Hyuk Lee1, Gi June Min1, Silvia Park1, Jae-Ho Yoon1,2, Sung-Eun Lee1,2, Byung-Sik Cho1,2, Ki-Seong Eom1,2, Yoo-Jin Kim1,2, Seok Lee1,2, Dong-Wook Kim1, 2
1Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 2Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Hee-Je Kim, M.D., Ph.D.
Address: Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: cumckim@catholic.ac.kr
Published online: August 30, 2021.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS).
Methods: A 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. 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.
Results: In the development cohort, advanced age, male sex, and comorbidities such as previous nonhematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. 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), highrisk (0.4< score ≤0.55), and very high-risk (score >0.55) groups. 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). 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). Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715.
Conclusion: The newly developed predictive scoring system may be a simple and reliable tool for alloSCT clinical decision-making in adults with acute leukemia.
Keywords: Comorbidity, Allogeneic, Transplantation, Stem cell, Acute leukemia, Score


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