PURPOSE Allogeneic hematopoietic stem cell transplantation (AHCT) outcomes depend on disease and patient characteristics. We previously developed a novel prognostic model, hematopoietic cell transplant composite-risk (HCT-CR) by incorporating the refined disease risk index (DRI-R) and hematopoietic cell transplant-comorbidity/age index (HCT-CI/Age) to predict post-transplant survival in patients with acute myeloid leukemia and myelodysplastic syndrome. Here we aimed to validate and prove the generalizability of the HCT-CR model in an independent cohort of patients with hematologic malignancies receiving AHCT. EXPERIMENTAL DESIGN Data of consecutive adult patients receiving AHCT for various hematologic malignancies were analyzed. Patients were stratified into four HCT-CR risk groups. The discrimination, calibration performance, and clinical net benefit of the HCT-CR model were tested. RESULTS The HCT-CR model stratified patients into four risk groups with significantly different overall survival (OS). Three-year OS was 67.4%, 50%, 37.5%, and 29.9% for low, intermediate, high, and very high-risk group, respectively (P < 0.001). The HCT-CR model had better discrimination on OS prediction when compared with the DRI-R and HCT-CI/Age (C-index was 0.69 vs. 0.59 and 0.56, respectively, P < 0.001). The decision curve analysis showed that HCT-CR model provided better clinical utility for patient selection for post-transplant clinical trial than the "treat all" or "treat none" strategy and the use of the DRI-R and HCT-CI/Age model separately. CONCLUSIONS The HCT-CR can be effectively used to predict post-transplant survival in patients with various hematologic malignancies. This composite model can identify patients who will benefit the most from transplantation and helps physicians in making decisions regarding post-transplant therapy to improve outcomes.

中文翻译：

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血液系统恶性肿瘤患者移植后生存预测的造血细胞移植复合风险（HCT-CR）模型的验证。

目的异基因造血干细胞移植（AHCT）的结果取决于疾病和患者特征。我们先前通过结合精细疾病风险指数（DRI-R）和造血细胞移植合并症/年龄指数（HCT-CI / Age）来开发新的预后模型，即造血细胞移植复合风险（HCT-CR）来预测急性髓细胞白血病和骨髓增生异常综合症患者的移植存活率。在这里，我们旨在验证和证明HCT-CR模型在接受AHCT的血液系统恶性肿瘤的独立队列中的可推广性。实验设计分析了连续接受AHCT的成年患者各种血液学恶性肿瘤的数据。将患者分为四个HCT-CR风险组。鉴别，校准性能，并测试了HCT-CR模型的临床净收益。结果HCT-CR模型将患者分为四个风险组，其总体生存期（OS）明显不同。低，中，高和极高风险组的三年OS分别为67.4％，50％，37.5％和29.9％（P <0.001）。与DRI-R和HCT-CI / Age相比，HCT-CR模型在OS预测上有更好的区分度（C指数分别为0.69、0.59和0.56，P <0.001）。决策曲线分析表明，与“全部治疗”或“不治疗”策略以及使用DRI-R和HCT-CI / Age模型相比，HCT-CR模型为移植后临床试验的患者选择提供了更好的临床实用性分别。结论HCT-CR可有效地预测各种血液系统恶性肿瘤患者的移植后存活率。该综合模型可以识别出将从移植中受益最大的患者，并帮助医生做出有关移植后治疗的决策，以改善治疗效果。