Comorbidities, alcohol use disorder, and age predict outcomes following autologous hematopoietic cell transplantation for lymphoma

Autologous hematopoietic cell transplantation (HCT) is a treatment option for many patients diagnosed with lymphoma. The effects of patient-specific factors on outcomes after autologous HCT are not well characterized. Here, we studied a sequential cohort of 754 patients with lymphoma treated with autologous HCT between 2000 and 2010. In multivariate analysis, patient-specific factors that were statistically significantly associated with non-relapse mortality (NRM) included hematopoietic cell transplantation comorbidity index (HCT-CI) scores of ≥ 3 (hazard ratio [HR] 1.94, P = 0.05), a history of alcohol use disorder (AUD) (HR 2.17, P = 0.004), and older age stratified by decade (HR 1.29, P = 0.02). HCT-CI ≥ 3, a history of AUD, and age > 50 were combined into a composite risk model: non-relapse and overall mortality rates at 5 years increased from 6% to 30% and 32% to 58%, respectively, in patients with zero versus all 3 risk factors. The HCT-CI is a valid tool in predicting mortality risks after autologous HCT for lymphoma. AUD and older age exert independent prognostic impact on outcomes. Whether AUD indicates additional organ dysfunction or socio-behavioral abnormality warrants further investigation. The composite model may improve risk-stratification prior to autologous HCT.