External Validation of the Revised Pretransplant Assessment of Mortality Score in Allogeneic Hematopoietic Cell Transplantation: A Cohort Study. Issue 4 (11th April 2022)

• Record Type: Journal Article
• Authors: Fattinger, Nicolas; Roth, Jan A.; Baldomero, Helen; Stolz, Daiana; Medinger, Michael; Heim, Dominik; Tamm, Michael; Halter, Jörg P.; Passweg, Jakob R.; Kleber, Martina
• Is Part Of: HemaSphere. Volume 6:Issue 4(2022)
• Page Start: e704
• Publication Date: 2022-04-11
• Subjects: Hematology -- Periodicals; 616.15005
• DOI: 10.1097/HS9.0000000000000704
• Languages: English
• ISSNs: 2572-9241

Abstract

Abstract : 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.