Journal Article

Adjusting DLCO for Hb and its effects on the Hematopoietic Cell Transplantation-specific Comorbidity Index

Smith, C, Coffey, D G, Myint, H, Pollyea, D A, Gutman, J A

2013

Overview

The Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) is used to counsel patients regarding the risk of transplantation and selection of conditioning regimens. Pulmonary disease, most frequently demonstrated by a decreased diffusion capacity of carbon monoxide (DLCO), is the most prevalent comorbidity captured by the HCT-CI. The HCT-CI was validated using the Dinakara method for adjusting DLCO for Hb, but our institution and others utilize the Cotes method. The purpose of this study was to determine the impact of using the Cotes method rather than the Dinakara method on the HCT-CI score. We reviewed pre-transplant pulmonary function tests in 73 patients who underwent allogeneic hematopoietic SCT. Patients were stratified into low, intermediate or high-risk groups based on HCT-CI scores of 0, 1–2 or ⩾3, respectively. We found that compared with the Dinakara method, the Cotes method increased the HCT-CI score in 45% of patients and resulted in total HCT-CI scores predictive of higher non-relapse mortality in 33% of patients. These results indicate that if an institution uses the Cotes method to adjust DLCO for Hb, their patients may be counseled to expect a higher risk of mortality than is actually predicted by the HCT-CI, and may be excluded from transplantation. Therefore, unless the HCT-CI is validated using other methods for correcting DLCO for Hb, the Dinakara method should be used.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/700/1750 / 692/700/565/545/576/1955 / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Bone marrow / Bone marrow, stem cells transplantation. Graft versus host reaction / Carbon monoxide / Carbon Monoxide - blood / Cell Biology / Comorbidity / Female / Hematologic Neoplasms - blood / Hematologic Neoplasms - surgery / Hematology / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic Stem Cell Transplantation - methods / Hematopoietic stem cells / Hemoglobins - metabolism / Humans / Internal Medicine / Lung diseases / Male / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Mortality / Prognosis / Public Health / Pulmonary Diffusing Capacity / Pulmonary functions / Respiratory function / Respiratory Function Tests - methods / Respiratory tract diseases / Retrospective Studies / Risk / Risk Factors / Risk groups / Stem cell transplantation / Stem Cells / technical-report / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation Conditioning - adverse effects / Transplantation Conditioning - methods / Transplantation, Homologous / Transplants & implants / Treatment Outcome / Young Adult