الفهرس 
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Abstract
Summary
Introduction:
Hematological stem cell transplantation (HSCT) has been an established curative treatment for an increasing number of patients with life-threatening hematological, oncological, genetic, and immunological illnesses since its inception in the 1950s. This has been made feasible thanks to global efforts in preclinical and clinical research focused on transplant immunology, reducing transplant-associated morbidity and mortality, and eradicating malignant illness effectively (Juric et al., 2016).
In patients with malfunctioning or depleted bone marrow, hematopoietic stem cell transplant (Bone marrow transplant) involves the introduction of viable hematopoietic stem cells through intravenous infusion. In cases like immunologic insufficiency, leukemias and other disorders, this serves to improve bone marrow function and permits, depending on the disease being treated, to either eradicate tumor cells with malignancy or make functional cells to replace the defective ones (Khaddour, et al., 2022)
Aim of the study:
The present study was conducted to fulfill the following aim:
Assess comorbidity index in predicting toxicity and mortality risk among patient undergoing hematopoietic stem cell transplantation through:
1. Assess comorbidities of patient’s pre-hematopoietic stem cell transplantation.
2. Assess toxicity and mortality risk post hematopoietic stem cell transplantation.
3. Assess the relation of pre-transplantation comorbidity scores and post transplantation-related toxicity and mortality in patients undergoing hematopoietic stem cell Transplantation.
Research questions:
Does the comorbidity index predict toxicity and mortality risk among patient undergoing hematopoietic stem cell transplantation?
Subject and Methods
Research Design:
A retrospective design was utilized to conduct this study.
Subject: A purposive sample of (44) patients undergoing allogeneic hematopoietic stem cell transplantation was recruited in this study.
Setting: This study conducted at The Bone Marrow Transplantation Unit in Nasser institute for research and treatment.
Tools of data collection:
The data were collected through using the following tools:
Tool I – Personal and medical related data:
It was developed by the researcher based on review of relevant recent related literature. It included three parts: demographic characteristics, clinical data pre hematopoietic stem cell transplantation, clinical data post hematopoietic cell transplantation.
Tool II - The hematopoietic stem cell transplantation specific-comorbidity index (HCT-CI): to assess pre-allogenic transplantation comorbidities and to predict probability of post-transplant mortality.
Tool III - Seattle Criteria for Organ Toxicity after Bone Marrow Transplantation: to assess the toxicity grading of eight organs post bone marrow transplantation.
Results:
The present study revealed that:
Regarding age the result revealed that the mean age of the study sample was 39.09±5.46. As regard to gender 61.4 % were males, 45.5 of them had acute myeloid leukemia. 52.3% had advanced phase of disease. Regarding source of stem cells, 81.8 % of them received stem cells from peripheral blood and 77.3 had Myeloablative conditioning regimen while 79.5 stayed in hospital more than 35 days. As regard to body mass index, 29.5% of the study sample had obesity grade II and grade III.
Regarding comorbidity index 86.4 was equally distributed on mild hepatic disorder and obesity respectively. And 27.3%, 11.4% and 9.1% of the studied patients had suspected or proven infection requiring treatment, diabetes, cardiac comorbidity respectively. While 47.7 % of the studied patients had an Intermediate toxicity and mortality risk.
As regard to organ toxicity, 18.2% of patients suffered from hepatic toxicity grade I, 36.4 % of patients suffered from stomatitis grade II. 18.2 % suffered from GIT toxicity grade I. 18.2% of patients suffered from pulmonary toxicity. 13.6% suffered from stomatitis grade III.
Regarding the total organ toxicity 84 % of the studied patients had a high toxicity score. While mortality rate was 9.1 % of the studied patients died post bone marrow transplantation.
Result revealed that there was a statistically significant correlation between mortality and obesity, cerebrovascular disease, cardiac disease. Also, there was highly significance correlation between comorbidity and Cardiac toxicity, Renal toxicity, Hepatic toxicity, CNS toxicity, Stomatitis. And positive Correlation between comorbidity, mortality and total organ toxicity post bone marrow transplantation.
Conclusion
The study revealed that the majority of the studied patients had a high toxicity score. 9.1 % of the studied patients died post bone marrow transplantation for patients with Hematopoietic stem cell transplantation. There was statistically significant correlation between mortality and patient’s comorbidity (obesity, cerebrovascular disease, cardiac disease, infection, renal disease, prior malignancy, hepatic disease and psychiatric disorder).
Recommendations:
• Further studies are recommended to assess Comorbidity Index in Predicting Toxicity and Mortality Risk among patient Undergoing Hematopoietic Stem Cell Transplantation
• Apply Comorbidity Index in predicting toxicity and mortality risk among patient undergoing Hematopoietic Stem Cell Transplantation.
Implication of the study:
Due to the spread of the Corona virus in 2021, the year of which the sample was collected, the number of cases was eligible for transplantation was reduced to the maximum level. The study outcome for which a prospective study is not feasible. Therefore, the study design was converted to a retrospective study.