Cardiopulmonary Exercise Test With Comorbidity Index Before Allogeneic Hematopoietic Stem Cell Transplantation.

Purpose: To evaluate the role of the cardiopulmonary exercise test (CPET) with comorbidity index as a predictor of overall survival (OS) and non-relapse mortality (NRM) in patients with hematological malignancies who undergo allogeneic hematopoietic stem cell transplantation (HSCT).

Methods: We retrospectively analyzed consecutive adult patients with hematological malignancies who underwent HLA-matched donor-HSCT at Chungnam National University Hospital (Daejeon, South Korea) between January 2014 and December 2020. Maximal oxygen consumption (VOmax) was classified using the recommendations of the Mayo Clinic database.

Results: Of 72 patients, 38 (52.8%) had VOmax values lower than the 25th percentile (VO ≤ 25) of an age- and sex-matched normal population. Patients with VOmax ≤ 25 had no significant differences both OS and NRM (30 month OS 29.8% vs 41%,  = .328; and 30 month NRM 16% vs 3.3%,  = .222), compared with other patients. VOmax ≤ 25 was assigned a weight of 1 when added to the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to form a composite comorbidity/CPET index (HCT-CI/CPET). Patients with HCT-CI/CPET scores of 0 to 1 demonstrated significantly better OS and NRM than did patients with HCT-CI/CPET scores ≥2 [median OS not reached vs 6 months,  < .001 and 30 month NRM 7.4% vs 33.3%,  = .006]. An HCT-CI/CPET score ≥2 was the only adverse risk factor for NRM on multivariate analysis [hazard ratio (HR) of NRM 10.36 (95% CI 1.486-2.25,  = .018)].

Conclusion: The composite HCT-CI/CPET score can predict the survival and mortality of patients with hematological malignancies who undergo allogeneic HSCT.