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.