Predicting mortality after autologous transplant: Development of a novel risk score.

Abstract There have been several efforts to predict mortality after autologous stem cell transplantation (ASCT), such as the Hematopoietic Cell Transplant-Comorbidity Index (HCT-CI), described for allogeneic-SCT and validated for ASCT, however there is no composite score in the setting of ASCT combining comorbidities with other clinical characteristics. Our aim is to describe a comprehensive score combining comorbidities with other clinical factors and to analyze the impact of this score on non-relapse mortality (NRM), overall survival (OS) and early morbidity end-points (mechanical ventilation, shock or dialysis) after ASCT. For the training cohort, we retrospectively reviewed data of 2068 adult patients who received an ASCT in Argentina (10/2002-06/2017) for multiple myeloma or lymphoma. For the validation cohort, we analyzed 2168 ASCT performed in the Medical College of Wisconsin and Spanish stem cell transplant group (GETH) (01/2012-12/2018). We first performed a multivariate analysis for NRM in order to select and assigned weight to the risk factors included in the score (male patients, age 55-64 and ≥65 years, HCT-CI ≥3, HL and NHL). The hazard ratio for NRM increased proportionally with the score. Patients were grouped as low risk (LR) with a score 0-1 (686, 33%), intermediate risk (IR) score 2-3 (1109, 53%), high risk (HR) score 4 (198, 10%) and very high risk (VHR) score ≥5 (75, 4%). The score was associated with a progressive increase in all the early morbidity endpoints. Moreover, the score was significantly associated with early NRM (day 100: 1.5% vs 2.4% vs 7.6% vs. 17.6%) as well as long term (1-3 years 1.8-2.3% vs. 3.8-4.9% vs. 11.7-14.5% vs. 25.0-27.4% respectively, p In conclusion, we developed and validated a novel score predicting NRM and OS in two large cohorts of more than 2000 autologous transplant patients. This tool can be useful for tailoring conditioning regimens or defining risk for transplant programs decision-making.