Comorbidity-age index: A clinical measure of biologic age before allogeneic hematopoietic cell transplantation

Abstract

Patients and Methods: Data from 3,033 consecutive recipients of HLA-matched grafts from five institutions contributed to this analysis. Patients were randomly divided into a training set to develop weights for age ntervals and a validation set to assess the performance of prognostic models. Purpose: Age has long been used as a major factor for assessing suitability for allogeneic hematopoietic cel transplantation (HCT). The HCT-comorbidity index (HCT-CI) was developed as a measure of health status to predict mortality risk after HCT. Whether age, comorbidities, or both should guide decision making for HCT is unknown. Results: In the training set, patients age 20 to 39 years, 40 to 49 years, 50 to 59 years, and ≥ 60 years had hazard ratios for nonrelapse mortality (NRM) of 1.21 (P =.29), 1.48 (P =.04), 1.75 (P =.004), and 1.84 (P =.005), respectively, compared with those age younger than 20 years. Consequently, age ≥ 40 years was assigned a weight of 1 to be added to the HCT-CI to constitute a composite comorbidity/age index. In the validation set, the composite comorbidity/age score had statistically significantly higher c-statistic estimates for prediction of NRM (0.664 v 0.556; P