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Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 51, pages 1283–1300 (2016)Cite this article

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Abstract

Cure of malignant and non-malignant hematological diseases is potentially possible after allogeneic hematopoietic stem cell transplantation (HCT). Accurate evaluation of the risk–benefit ratio for an individual patient could improve the decision-making process about transplant, which ultimately would increase the likelihood of success. Several transplant-related models were designed in an effort to optimize decision-making about suitable candidates for allogeneic HCT. In 1998, The European Society for Blood and Marrow Transplantation (EBMT) developed a five-component pretransplantation risk scoring system for patients with CML. The EBMT score was later tested in patients with various hematological disorders, and it was shown to stratify risks of mortality after allogeneic HCT. More recent research efforts focused on models that assess health status before HCT. A HCT-specific comorbidity index was designed to assign weights to 17 relevant comorbidities that were shown to independently predict non-relapse mortality. Performance status scales and comprehensive geriatric assessment tools might uncover additional overall health limitations that affect long-term survival among older recipients of allogeneic HCT. Other models include the pretransplantation assessment of mortality score that summarizes the impacts of eight different pretransplantation patient- and disease-specific variables into a 50-point model that predicts survival. The disease-risk index captures the impact of primary diagnoses and disease status on relapse and survival following allogeneic HCT. The values and limitations of each model are discussed herein. We also provide insight on how to use these models in the clinic to decide about offering allogeneic HCT with the most suitable conditioning regimen intensity.

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Acknowledgements

We are grateful to the help by Bonnie Larson and Helen Crawford in manuscript preparation. MLS was supported by funding from Pathway to Independence Grant HL088021 from the National Institutes of Health; Research Scholar Grant #RSG-13-084-01-CPHPS from the American Cancer Society and a Patient-Centered Outcome Research Institute contract #CE-1304-7451. ME was supported by Grant JS2865 from the Egyptian Ministry of Higher Education.

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Authors and Affiliations

  1. Clinical Research Division, Transplantation Biology Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    M Elsawy & M L Sorror

  2. Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

    M Elsawy

  3. Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

    M L Sorror

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  1. M Elsawy
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  2. M L Sorror
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Correspondence to M L Sorror.

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Elsawy, M., Sorror, M. Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 51, 1283–1300 (2016). https://doi.org/10.1038/bmt.2016.141

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