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      Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation

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          Abstract

          Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is still associated with a high transplant-related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict the outcome after allogeneic HSCT for acquired hematological disorders. Objectives. The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on South Brazilian patients. Methods. A retrospective observational study was performed based on patients' records and data base at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS). Nonrelapse mortality (NRM) and relapse rate (RR) were analyzed. Results. There were 278 evaluable patients. OS, NRM, and RR at five years median followup were 48.7%, 40.7%, and 30.7%, respectively. The OS was 81.8% for risk score 0 and 0% for score 6 ( P < 0.001), and NRM was 13.6% and 80% for risk scores 0 and 6, respectively ( P = 0.001). Conclusion. The EBMT risk score can be utilized as a tool for clinical decision making before allogeneic HSCT for malignant hematological diseases and severe aplastic anemia at a single center in Brazil.

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          How we treat cytomegalovirus in hematopoietic cell transplant recipients.

          Michael Boeckh, Per Ljungman (2009)
          Cytomegalovirus (CMV) continues to cause major complications after hematopoietic cell transplantation (HCT). Over the past decade, most centers have adopted preemptive antiviral treatment or prophylaxis strategies to prevent CMV disease. Both strategies are effective but also have shortcomings with presently available drugs. Here, we review aspects of CMV treatment and prevention in HCT recipients, including currently used drugs and diagnostics, ways to optimize preemptive therapy strategies with quantitative polymerase chain reaction assays, the use of prophylaxis, management of CMV disease caused by wild-type or drug-resistant strains, and future strategies.
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            Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis.

            Martin Stern, Alois Gratwohl, Ronald Brand … (2009)
            It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general. Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5-77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005. Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%-73%) for risk score 0 for the whole cohort (75%, 95% CI, 72%-78% for the most recent time cohort) to 24% (95% CI, 21%-27% for risk score 6 and 7; 25%, 95% CI, 22%-29% most recent cohort). Transplant-related mortality increased from 15% (95% CI, 14%-17%) for risk score 0 (11%, 95% CI, 9%-13%, most recent cohort) to 47% with risk score 6 and 7 (95% CI, 44%-50%) for the whole cohort (45%, 95% CI, 42%-48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques. Five well-defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies. Copyright (c) 2009 American Cancer Society.
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              The EBMT risk score.

              A. Gratwohl (2012)
              The European Group for Blood and Marrow Transplantation (EBMT) risk score provides a simple tool to assess instantly chances and risks of hematopoietic SCT(HSCT) for an individual patient pre-transplant. Five factors, age of the patient, stage of the disease, time from diagnosis, donor type and donor recipient gender combination augment risk for an individual patient with increasing score from 0 as best to 7 as worst in an additive way. The score holds for all acquired hematological disorders, for allogeneic and autologous HSCT (score 0-5), is independent of the HSCT technology and is valid for standard or reduced intensity conditioning. Survival is uniformly worse for older patients, transplanted in advanced disease stage after a long-time interval and with a mismatched donor than for younger patients, transplanted soon in early stage with a well matched donor. Additional risk factors such as performance score, CMV serostatus or cytokine polymorphisms improve prediction but to different extents for low or high-risk patients. Comparative assessment of disease risk and global pre-transplant risk should guide decisions for each patient with his/her specific disease between HSCT and a non-transplant approach and replace the traditional 'donor vs no donor' with such a risk-adapted individualized strategy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Bone Marrow Res
                Journal ID (iso-abbrev): Bone Marrow Res
                Journal ID (publisher-id): BMR
                Title: Bone Marrow Research
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-2999
                ISSN (Electronic): 2090-3006
                Publication date (Print): 2013
                Publication date (Electronic): 12 December 2013
                Volume: 2013
                Electronic Location Identifier: 565824
                Affiliations
                1Hematology and Bone Marrow Transplantation, Clinical Hospital of Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
                2Laboratory of Cell Culture and Molecular Analysis of Hematopoietic Cells, Clinical Hospital of Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
                Author notes

                Academic Editor: Peter J. Quesenberry

                Author information
                http://orcid.org/0000-0002-4454-9439
                http://orcid.org/0000-0002-4929-7525
                http://orcid.org/0000-0001-9148-0908
                Article
                DOI: 10.1155/2013/565824
                PMC ID: 3876681
                SO-VID: 60de1ffe-8d92-44fb-99c5-d60856cd1647
                Copyright © Copyright © 2013 Beatriz Stela Pitombeira et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 21 August 2013
                Date revision received : 4 November 2013
                Date accepted : 6 November 2013
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Neurology
                Data availability:
                ScienceOpen disciplines: Neurology

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