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

Reduced-intensity conditioning (RIC) regimens have long-term outcomes that are generally comparable to those with myeloablative conditioning (MAC) due to a lower risk of 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 50-69 years using a Japanese registry database. Based on the interaction analyses, advanced age (≥ 60 y), 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 nonrelapse mortality (NRM) between MAC and RIC - the RICE score, which is the sum of these three factors: 0 or 1, low RICE score; or 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: HR, 0.73, 95%CI, 0.60-0.90, P = 0.003; validation cohort: HR, 0.57, 95%CI, 0.43-0.77, P < 0.001). 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 = 0.860; validation cohort: HR, 0.81, 95%CI, 0.66-1.01, P = 0.061). In summary, a new and simple scoring system, the RICE score, appears to be useful for personalizing the conditioning intensity and might improve transplant outcomes in elderly patients.