Novel risk assessment for the intensity of conditioning regimen in older patients

Yu Akahoshi, Yuma Tada, Emiko Sakaida, MacHiko Kusuda, Noriko Doki, Naoyuki Uchida, Takahiro Fukuda, Masatsugu Tanaka, Masashi Sawa, Yuta Katayama, Ken Ichi Matsuoka, Yukiyasu Ozawa, Makoto Onizuka, Junya Kanda, Yoshinobu Kanda, Yoshiko Atsuta, Hideki Nakasone

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Reduced-intensity conditioning (RIC) regimens have long-term outcomes that are generally comparable with those of myeloablative conditioning (MAC) because of a lower risk of nonrelapse mortality (NRM) but a higher risk of relapse. However, it is unclear how we should select the conditioning intensity in individual cases. We propose the risk assessment for the intensity of conditioning regimen in elderly patients (RICE) score. We retrospectively analyzed 6147 recipients aged 50 to 69 years using a Japanese registry database. Based on the interaction analyses, advanced age (≥60 years), hematopoietic cell transplantation-specific comorbidity index (≥2), and umbilical cord blood were used to design a scoring system to predict the difference in an individual patient's risk of NRM between MAC and RIC: the RICE score, which is the sum of the 3 factors. Zero or 1 implies low RICE score and 2 or 3, high RICE score. In multivariate analyses, RIC was significantly associated with a decreased risk of NRM in patients with a high RICE score (training cohort: hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.60-0.90; P = .003; validation cohort: HR, 0.57; 95% CI, 0.43-0.77; P < .001). In contrast, we found no significant differences in NRM between MAC and RIC in patients with a low RICE score (training cohort: HR, 0.99; 95% CI, 0.85-1.15; P = .860; validation cohort: HR, 0.81; 95% CI, 0.66-1.01; P = .061). In summary, a new and simple scoring system, the RICE score, appears to be useful for personalizing the conditioning intensity and could improve transplant outcomes in older patients.

Original languageEnglish
Pages (from-to)4738-4747
Number of pages10
JournalBlood Advances
Volume7
Issue number17
DOIs
Publication statusPublished - Sept 12 2023
Externally publishedYes

ASJC Scopus subject areas

  • Hematology

Fingerprint

Dive into the research topics of 'Novel risk assessment for the intensity of conditioning regimen in older patients'. Together they form a unique fingerprint.

Cite this