Machine learning-based prediction of one-year mortality after alloHCT identifies the impact of pre-transplant immunity and inflammation.
Accurate prediction of mortality after allogeneic hematopoietic stem cell transplantation (alloHCT) is essential for individualized treatment decisions, yet existing clinical risk scores capture only a limited number of variables and show modest predictive performance. In our single-center retrospective analysis, we included data from 909 adult patients with hematologic malignancies undergoing alloHCT. We used 31 features to build machine-learning models to predict death within the first year after alloHCT. These features included established clinical risk factors together with pre-transplant lymphocyte subsets and inflammatory markers. Among four models, a random forest algorithm showed the best performance (AUC = 0.773) and retained good generalizability in an independent test set (AUC = 0.748). SHapley Additive exPlanations (SHAP)-based interpretation of the machine-learning models showed that age together with five easily measurable pre-transplant immunological and inflammatory parameters influenced the outcome: pre-transplant CD4+, CD8+, and B-lymphocyte counts, albumin, and C-reactive protein (CRP) levels. Based on these features, our random forest approach outperformed established clinical risk scores (HCT-CI, EASIX, rDRI, mGPS) in predicting one-year mortality after alloHCT and more effectively distinguished patients at low and high risk of an adverse outcome. Our study shows that machine-learning-based models can not only predict patient outcomes after alloHCT but also serve as powerful tools for data exploration, confirming the prognostic relevance of pre-transplant inflammation while uncovering the critical role of lymphocyte subsets as previously unknown risk factors. External validation in independent multicenter cohorts will be required to confirm generalizability.
Authors
Meyer Meyer, Meyer Meyer, Hackenberg Hackenberg, Oelke Oelke, Gengenbach Gengenbach, Rummelt Rummelt, Wilcken Wilcken, Maas-Bauer Maas-Bauer, Wäsch Wäsch, Duyster Duyster, Bertz Bertz, Duque-Afonso Duque-Afonso, Finke Finke, Zeiser Zeiser, Wehr Wehr
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