Abstract 4286

Introduction:

Patients (pts) who undergo autologous stem cell transplant (ASCT) for lymphoma and multiple myeloma (MM) are often older and frequently have multiple comorbidities, as well as diminished performance status (PS). The presence of comorbidities has been shown to influence overall survival (OS) following ASCT for non-Hodgkin's lymphoma, but not for MM, and comorbidity indices can predict readmission in multiple settings. The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) can predict risk of readmission following allo-SCT, but this has not been evaluated for ASCT.

Methods:

We conducted an analysis of 688 consecutive pts who received ASCT at the Ohio State University from 2000–2010 for lymphoma or MM in order to identify pre-transplant factors associated with readmission and early mortality. Univariate and multivariate logistic regression were used to predict the odds of readmission within the first 100 days following ASCT or the odds of death within the first 100 days. Cox regression was used to evaluate OS.

Results:

408 (59%) of pts were male, 46 (7%) were age ≥70, 367 (53%) had MM and 322 (47%) had lymphoma (110 Hodgkin's lymphoma, 125 diffuse large B cell lymphoma (DLBCL), 17 follicular lymphoma, 51 mantle cell lymphoma, 17 peripheral T cell lymphoma, 2 gray zone). The most common conditioning regimens were melphalan (327), BEAM (167), and BuCyVP (110). Sixty five percent had a Karnofsky PS (KPS) of ≥90. HCT-CI score was available in 431 patients and was 0 in 99 (23%), 1–2 in 169 (39%), and ≥3 in 163 (38%). 14% were readmitted within 100 days of transplant, and 4% died within the first 100 days. On univariate analysis, increased odds of readmission were significantly associated with conditioning with BuCyVP relative to melphalan, KPS≤80, and HCT-CI≥3 (Table 1). In transplants after 2006 when HCT-CI was incorporated as standard of care, HCT-CI≥3 remained statistically significant for readmission (OR 2.54, 95% CI 1.15–5.56). Mortality within 100 days was associated with readmission, gender, DLBCL vs MM, KPS≤80, and use of plerixafor for mobilization on univariate analysis. Early mortality was significantly associated with female sex (OR 0.16, 95% CI 0.03–0.66) and readmission within 100 days (OR 3.90, 95% CI 1.3–11.6) on multivariate analysis. After excluding patients who died within the first 30 days and who relapsed within the first 100 days, readmission within 100 days of transplant (HR 1.75, 95% CI 1.21–2.56, p=0.003) (Figure 1), and KPS≤80 (HR 1.41, 95% CI 1.05–1.87, p=0.02) are associated with inferior OS, but HCT-CI was not.

Conclusion:

While an HCT-CI score ≥3 was associated with readmission, it was not associated with early mortality or OS in pts with MM or lymphoma. Readmission within 100 days and KPS≤80 were significantly associated with inferior OS, and readmission was significantly associated with early mortality. Evaluation of other assessment tools, including frailty assessments, may identify patients who could benefit from earlier rehabilitative interventions, either prior to or following ASCT.

Table 1.

Univariate analysis

Readmission (N=99)Day 100 Mortality (N=29)
ORpORp
Patient age     
    ≥70/<70 1.75 0.14 1.66 0.42 
Gender     
    Female/male 0.88 0.55 0.29 0.003 
Diagnosis     
    HL/MM 0.59 0.13 1.03 0.96 
    DLBCL/MM 0.85 0.57 2.37 0.047 
    FL/MM 0.33 0.28 1.7 0.62 
    MCL/MM 1.12 0.74 0.78 0.56 
Response to tx     
    Chemoresistant/sensitive 1.21 0.54 1.74 0.24 
KPS     
    KPS≤80/KPS≥90 1.94 0.002 2.26 0.04 
CMI (N=431)     
    1-2/0 1.57 0.27 0.58 0.44 
    ≥3/0 2.53 0.02 1.07 0.92 
Previous radiation     
    Y/N 0.96 0.88 1.79 0.14 
Previous treatment     
    ≥3/≤2 1.44 0.18 0.78 0.74 
Mobilization (N=595)     
    Plerixafor/G-CSF alone 1.14 0.69 3.47 0.024 
    Chemo/G-CSF alone 1.03 0.89 1.36 0.57 
Conditioning     
    BEAM/mel 0.82 0.44 1.53 0.38 
    BuCyVP/mel 0.45 0.03 1.73 0.3 
    CD34 count (N=467) 0.98 0.64 0.82 0.2 
Readmission (N=99)Day 100 Mortality (N=29)
ORpORp
Patient age     
    ≥70/<70 1.75 0.14 1.66 0.42 
Gender     
    Female/male 0.88 0.55 0.29 0.003 
Diagnosis     
    HL/MM 0.59 0.13 1.03 0.96 
    DLBCL/MM 0.85 0.57 2.37 0.047 
    FL/MM 0.33 0.28 1.7 0.62 
    MCL/MM 1.12 0.74 0.78 0.56 
Response to tx     
    Chemoresistant/sensitive 1.21 0.54 1.74 0.24 
KPS     
    KPS≤80/KPS≥90 1.94 0.002 2.26 0.04 
CMI (N=431)     
    1-2/0 1.57 0.27 0.58 0.44 
    ≥3/0 2.53 0.02 1.07 0.92 
Previous radiation     
    Y/N 0.96 0.88 1.79 0.14 
Previous treatment     
    ≥3/≤2 1.44 0.18 0.78 0.74 
Mobilization (N=595)     
    Plerixafor/G-CSF alone 1.14 0.69 3.47 0.024 
    Chemo/G-CSF alone 1.03 0.89 1.36 0.57 
Conditioning     
    BEAM/mel 0.82 0.44 1.53 0.38 
    BuCyVP/mel 0.45 0.03 1.73 0.3 
    CD34 count (N=467) 0.98 0.64 0.82 0.2 
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Figure 1.
Figure 1. Overall survival by readmission within 100 days
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Overall survival by readmission within 100 days

Figure 1.
Figure 1. Overall survival by readmission within 100 days
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Overall survival by readmission within 100 days

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
autologous stem cell transplant, comorbidity, hematopoietic stem cell transplantation, lymphoma, multiple myeloma, patient readmission, brachial plexus neuritis, diffuse large b-cell lymphoma, transplantation, granulocyte colony-stimulating factor

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2012 by The American Society of Hematology
2012
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