Open AccessExternal Validation of the Revised Pretransplant Assessment of Mortality Score in Allogeneic Hematopoietic Cell Transplantation: A Cohort Study
Author(s) -
Fattinger Nicolas,
Roth Jan A.,
Baldomero Helen,
Stolz Daiana,
Medinger Michael,
Heim Dominik,
Tamm Michael,
Halter Jörg P.,
Passweg Jakob R.,
Kleber Martina
Publication year - 2022
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/hs9.0000000000000704
Subject(s) - medicine , hazard ratio , confidence interval , cohort , receiver operating characteristic , cumulative incidence , transplantation , hematopoietic stem cell transplantation , population , hematopoietic cell , incidence (geometry) , framingham risk score , disease , haematopoiesis , stem cell , physics , environmental health , biology , optics , genetics
Pretransplant risk scores such as the revised Pretransplant Assessment of Mortality (rPAM) score help to predict outcome of patients receiving allogeneic hematopoietic cell transplantation (allo‐HCT). Since the rPAM has not been validated externally in a heterogeneous patient population with different diseases, we aimed to validate the rPAM score in a real‐world cohort of allo‐HCT patients. A total of 429 patients were included receiving their first allo‐HCT from 2008 to 2015. The predictive capacity of the rPAM score for 4‐year overall survival (OS), nonrelapse mortality (NRM), and cumulative incidence of relapse (CIR) after allo‐HCT was evaluated. Moreover, we evaluated the impact of the rPAM score for OS and used uni‐ and multivariable analyses to identify patient‐ and transplant‐related predictors for OS. In rPAM score categories of <17, 17–23, 24–30, and >30, the OS probability at 4 years differed significantly with 61%, 36%, 26%, and 10%, respectively ( P < 0.0001). In contrast to CIR, the NRM increased significantly in patients with higher rPAM scores ( P < 0.001). Regarding the OS, the rPAM score had an area under the receiver operating characteristics curve of 0.676 (95% confidence interval [CI], 0.625‐0.727) at 4 years. In the multivariable analysis, the rPAM score was associated with OS—independently of conditioning regimens (adjusted hazard ratio per 1‐unit increase, 1.10; 95% CI, 1.06‐1.10; P < 0.001). Additionally, forced expiratory volume in 1 second and the disease risk index were the components of the rPAM significantly associated with outcome. In our large real‐world cohort with extended follow‐up, the rPAM score was validated as an independent predictor of OS in patients with hematologic disorders undergoing allo‐HCT.