Share on LinkedInTweet about this on TwitterShare on Facebook

Risicoclassificatie

Versie:
3.0
Publicatiedatum:
29 aug 2017
Auteur(s):
Ellen Meijer

1. DRI (= Disease risk index)

Risicoclassificaties per ziekte worden bepaald aan de hand van de DRI tool.

2. HCT-CI (=Hematopoietic stemcell transplantation-comorbidity index)

Seattle HCT-Comorbidity Index: AlloSCT non-relapse mortality risk score

Comorbidity

Definitions of comorbidities included in the

new HCT-CI

HCT-CI weighted scores

Score

Arrhythmia

Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias

1

 

Cardiac

Coronary artery disease a, congestive heart failure, myocardial infarction, or EF ≤ 50%

1

 

Inflammatory bowel disease

Crohn disease or ulcerative colitis

1

 

Diabetes

Requiring treatment with insulin or oral hypoglycemics but not diet alone

1

 

Cerebrovascular disease

Transient ischemic attack or cerebrovascular accident

1

 

Psychiatric disturbance

Depression or anxiety requiring psychiatric consult or treatment

1

 

Hepatic, mild

Chronic hepatitis, bilirubin > ULN to 1.5 x ULN, or AST / ALT > ULN to 2.5 x ULN

1

 

Obesity

Patients with a body mass index > 35 kg/m2

1

 

Infection

Requiring continuation of antimicrobial treatment after day 0

1

 

Rheumatologic

SLE, RA, polymyositis, mixed CTD, or polymyalgia rheumatica

2

 

Peptic ulcer

Requiring treatment

2

 

Moderate / severe renal

Serum creatinine > 177 µmol/L, on dialysis, or prior renal transplantation

2

 

Moderate pulmonary

DLco and / or FEV1 66% – 80% or dyspnea on slight activity

2

 

Prior solid tumor

Treated at any time point in the patient’s past history, excluding nonmelanoma skin cancer

3

 

Heart valve disease

Except mitral valve prolapse

3

 

Severe pulmonary

DLco and / or FEV1 ≤ 65% or dyspnea at rest or requiring oxygen

3

 

Moderate / severe hepatic

Liver cirrhosis, bilirubin > 1.5 x ULN, or AST / ALT > 2.5 x ULN

3

 
   

Total score:

 

a One or more vessel-coronary artery stenosis requiring medical treatment, stent, or bypass graft.

 

Voor leeftijd ≥ 40 komt er 1 punt bij de score.

3. Prediction model for mortality 100 days following allogeneic SCT

The European Society for Blood and Marrow Transplantation – Alternating Decision Tree (EBMT-ADT) prediction model for mortality 100 days following allogeneic hematopoietic stem cell transplantation. Zie bijgevoegd artikel.

 

http://bioinfo.lnx.biu.ac.il/~bondi/web1.html

 

4. 2017 European LeukemiaNet risk stratification by genetics

Risk Categorya

Genetic Abnormalityb

Favorable

t(8;21)(q22;q22.1); RUNX1-RUNX1T1

 

inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11

 

Mutated NPM1 without FLT3-ITD or with FLT3-ITDlowc

 

Biallelic mutated CEBPA

Intermediate

Mutated NPM1 and FLT3-ITDhighc

 

Wild type NPM1 without FLT3-ITD or with FLT3-ITDlowc (w/o adverse-risk genetic lesions)

 

t(9;11)(p21.3;q23.3); MLLT3-KMT2Ad

 

Cytogenetic abnormalities not classified as favorable or adverse

Adverse

t(6;9)(p23;q34.1); DEK-NUP214

 

t(v;11q23.3); KMT2A rearranged

 

t(9;22)(q34.1;q11.2); BCR-ABL1

 

inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM(EVI1)

 

-5 or del(5q); -7; -17/abn(17p)

 

Complex karyotypee monosomal karyotypef

 

Wild type NPM1 and FLT3-ITDhighc

 

Mutated RUNX1g

 

Mutated ASXL1g

 

Mutated TP53h

a

Frequencies, response rates and outcome measures should be reported by risk category, and, if sufficient numbers are available, by specific genetic lesions indicated.

b

Prognostic impact of a marker is treatment-dependent and may change with new therapies.

c

Low, low allelic ratio (< 0.5); high, high allelic ratio (> 0.5); semi-quantitative assessment of FLT3-ITD allelic ratio (using DNA fragment analysis) is determined as ratio of the area under the curve (AUC) “FLT3-ITD” divided by AUC “FLT3-wild type”; recent studies indicate that acute myeloid leukemia with NPM1 mutation and FLT3-ITD low allelic ratio may also have a more favorable prognosis and patients should not routinely be assigned to allogeneic hematopoietic-cell transplantation.

d

The presence of t(9;11)(p21.3;q23.3) takes precedence over rare, concurrent adverse-risk gene mutations.

e

Three or more unrelated chromosome abnormalities in the absence of one of the World Health Organization-designated recurring translocations or inversions, i.e., t(8;21), inv(16) or t(16;16),

t(9;11), t(v;11)(v;q23.3), t(6;9), inv(3) or t(3;3); AML with BCR-ABL1.

f

Defined by the presence of one single monosomy (excluding loss of X or Y) in association with at least one additional monosomy or structural chromosome abnormality (excluding core-binding factor AML).

g

These markers should not be used as an adverse prognostic marker if they co-occur with favorable-risk AML subtypes.

h

TP53 mutations are significantly associated with AML with complex and monosomal karyotype.