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Graft-Versus-Host Disease

Comorbidity burden in patients with chronic GVHD

Bone Marrow Transplantation volume 48, pages 1429–1436 (2013)Cite this article

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Abstract

Chronic GVHD (cGVHD) is associated with mortality, disability and impaired quality of life. Understanding the role of comorbidity in patients with cGVHD is important both for prognostication and potentially for tailoring treatments based on mortality risks. In a prospective cohort study of patients with cGVHD (n=239), we examined the performance of two comorbidity scales, the Functional Comorbidity Index (FCI) and the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI). Both scales detected a higher number of comorbidities at cGVHD cohort enrollment than pre-hematopoietic cell transplant (HCT) (P<0.001). Higher HCT-CI scores at the time of cGVHD cohort enrollment were associated with higher non-relapse mortality (HR: 1.21:1.04–1.42, P=0.01). For overall mortality, we detected an interaction with platelet count. Higher HCT-CI scores at enrollment were associated with an increased risk of overall mortality when the platelet count was ⩽100 000/μL (HR: 2.01:1.20–3.35, P=0.01), but not when it was >100 000/μL (HR: 1.05:0.90–1.22, P=0.53). Comorbidity scoring may help better to predict survival outcomes in patients with cGVHD. Further studies to understand vulnerability unrelated to cGVHD activity in this patient population are needed.

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Acknowledgements

This work was supported by National Institutes of Health/National Cancer Institute grant CA 118953 as well as grant KL2TR000084.

Author contributions

DW, PJM, CC, JP, JP, MA, SA, MJ and SJL contributed clinical data; XC and BS performed statistical analysis and drafted the manuscript; WW and SJL designed research and drafted the manuscript; and all authors contributed to analysis and interpretation of data and critical review of the manuscript.

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Authors and Affiliations

  1. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill,

    W A Wood

  2. Chapel Hill, NC, USA

    W A Wood

  3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    X Chai, P J Martin, Y Inamoto, B Storer & S J Lee

  4. Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA

    D Weisdorf & M Arora

  5. Hematologic Malignancies, Dana Farber Cancer Institute, Boston, MA, USA

    C Cutler

  6. Department of Hematology and Clinical Oncology, University of Regensburg, Regensburg, Germany

    D Wolff

  7. National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    S Z Pavletic & S Mitchell

  8. Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA

    J Pidala

  9. Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    J M Palmer

  10. Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA, USA

    S Arai

  11. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    M Jagasia

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  1. W A Wood
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  2. X Chai
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  7. D Wolff
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  8. S Z Pavletic
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  11. M Arora
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  13. M Jagasia
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  14. B Storer
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  15. S J Lee
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  16. S Mitchell
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Correspondence to W A Wood.

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The authors declare no conflict of interest.

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Wood, W., Chai, X., Weisdorf, D. et al. Comorbidity burden in patients with chronic GVHD. Bone Marrow Transplant 48, 1429–1436 (2013). https://doi.org/10.1038/bmt.2013.70

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  • DOI: https://doi.org/10.1038/bmt.2013.70

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