Supplementary Table 1. Comparison of different comorbidity scores: Kaplan-Feinstein-Index (KF), Charlson-Comorbidity-Index (CCI), Satariano-index (SI) and Hematopoietic cell transplantation-specific comorbidity Index (HCT-CI)
Variables / Kaplan-Feinstein-Index(KF) / Charlson-Comorbidity-Index (CCI) / Satariano-Index
(SI) / Hematopoietic cell transplantation-specific Comorbidity Index (HCT-CI)
Development / 1973 / 1984 / 1994 / 2005
Patient cohort of development / Comorbidities and prognostic value in patients with diabetes mellitus (5-year-mortality) / Developed by assigning chronic conditions (1-year mortality) in patients admitted to general medical center, validated in breast cancer patients (10-year mortality) / Strong predictor of 3-year survival in breast cancer patients / Prognostic relevance of pretransplant comorbidities, based and developed on CCI
# of comorbidities / 12 / 20 / 7 / 17
Comorbid conditions / cardiovascular-, respiratory-, gastrointestinal-, renal, neurologic-, psychiatric-, and immunologic conditions, malignancies, locomotor impairment and substance abuse / gastrointestinal-, cerebrovascular-, chronic pulmonary-, endocrine diseases, cardiovascular conditions, renal impairment, malignancies, AIDS and age / myocardial infarction, other types of heart disease, diabetes, respiratory conditions, liver conditions, gallbladder and other underlying cancer / gastrointestinal-, cardiac-, pulmonary-, endocrine disease, hypertension, arrhythmia, inflammatory bowel, diabetes, cerebrovascular-, rheumatologic-, renal disease, psychiatric disturbance, prior solid tumor, peptic ulcer, heart disease, obesity and infection
Weighted vs. non-weighted / Weighted / Weighted / Non-weighted / Weighted
Counting points / Each comorbidity according to category system of 1,2 or 3 points / 1,2,3 and 6 points / 1 point / 1,2 or 3 points
End score / Highest score remains endscore / Sum score / Sum score / Sum score
Maximum scoring points / 3 / 33
(extra point for every age decade, starting at 50 years) / 7 / 26
Definition / No sum score; results in low end score of max. 3 points / Widely used / Non-weighted – severity of comorbidities not assessed, renal function not included / Focused on hematological patients, used in pretransplant candidates
Supplementary Table 2. Patient characteristics and comorbidity assessment in different age groups
n (%) / median (range) / n (%) / median (range) / n (%) / median (range)
Age (year) / 52 (27-59) / 64 (60-69) / 74 (70-83)
KPS (%) / 90 (50-100) / 80 (40-100) / 80 (50-90)
Durie&Salmon stage
II / III / 53 (87) / 44 (98) / 19 (90)
A : B / 57 (93) : 4 (7) / 38 (86) : 7 (14) / 13 (62) : 8 (38)
ISS stage
II / III / 10 (29) / 13 (29) / 8 (73)
ß2-microglobulin (mg/dl) / 2.7 (1-8) / 3 (2-23) / 7 (2-19)
PC BM-Infiltration rate (%) / 40 (0-90) / 30 (0-80) / 50 (6-90)
Cytogenetics (FISH)
Deletion 13q14 / 10 (33) / 4 (20) / 2 (33)
Comorbidities
Lung disease, moderate-severe / 10 (16) / 9 (20) / 4 (19)
Cardiac impairment, moderate-severe / 10 (16) / 9 (20) / 6 (29)
Hypertension, moderate-severe / 7 (11) / 8 (18) / 6 (29)
Hepatic impairment, moderate-severe / 2 (3) / 5 (11) / 0
Pain despite of therapy / 25 (41) / 24 (53) / 10 (83)
Diabetes mellitus / 4 (7) / 5 (11) / 4 (19)
Additional malignancy apart from MM / 2 (3) / 4 (9) / 2 (10)
eGFR <30ml/min/1.73m2 / 7 (11) / 5 (11) / 6 (29)
CI high-risk group
FCI>0 / 15 (25) / 0 (0-1) / 19 (42) / 0 (0-3) / 8 (38) / 0 (0-3)
HCT-CI >1 / 14 (23) / 0 (0-5) / 24 (53) / 2 (0-10) / 11 (52) / 1 (0-7)
CCI>5 / 7 (11) / 3 (2-9) / 17 (38) / 5 (2-10) / 14 (67) / 6 (5-12)
KF>2 / 12 (20) / 1 (0-3) / 19 (42) / 2 (0-3) / 8 (38) / 2 (0-3)
SI>1 / 14 (23) / 0 (0-3) / 11 (24) / 1 (0-4) / 8 (38) / 1 (0-2)
Standard therapy : auto PBSCT / 18 (30): 43 (70) / 27(60) : 18 (40) / 20 (95) : 1 (5)
Abbreviation: KPS: Karnofsky-Performance Status; BMI: Body Mass Index, ISS: International Staging System, PC BM-Infiltration rate: plasma cell bone marrow infiltration rate, eGFR: estimated glomerular filtration rate, CKD: chronic kidney disease stages according to K/DOQI guidelines defined by MDRD: Modification of Diet in Renal Disease: estimated GFR (ml/min/1.73m²)= 186 x (serum creatinine level [in milligrams per deciliter])-1.154 x (age [in years])-0.203 x (0.742 if female, 1.21 if black), FISH: Fluorescence in situ hybridization, auto-PBSCT: autologous peripheral blood stem cell transplantation, CI: comorbidity index; high-risk-group: >median score points, FCI: Freiburger comorbidity index, HCT-CI: Hematopoetic cell transplantation-specific comorbidity index, CCI: Charlson-Comorbidity-index, KF: Kaplan-Feinstein index; SI: Satariano index
High dose therapy (n=62) / Standard therapy (n=65)Comorbidity / n (%) / median (range) / n (%) / median (range)
Lung disease
No / mild / 56 (90) / 48 (74)
Moderate / severe / 6 (10) / 17 (26)
eGFRMDRD (ml/min/1.73m2) / 107(17-182) / 76 (6-170)
90-60 / 56 (90) / 43 (66)
59-30 / 4 (6) / 12 (19)
<30 / 2 (4) / 10 (15)
KPS (%) / 90 (40-100) / 80 (40-100)
100 / 24 (38) / 11 (17)
80-90 / 24 (38) / 29 (45)
<80 / 14 (24) / 25 (38)
Age (year) / 54 (27-70) / 64 (32-83)
>59 / 30 (48) / 53 (82)
≤ 59 / 32 (52) / 12 (18)
Cardiac impairment
No / mild / 50 (81) / 52 (80)
Moderate / severe / 12 (19) / 13 (20)
Hypertension (despite of therapy) / 1 (2) / 3 (5)
Diabetes mellitus / 6 (10) / 7 (11)
Hepatic impairment
No / mild / 59 (95) / 61 (94)
Moderate / severe / 3 (5) / 4 (6)
Pain despite of therapy / 26 (42) / 33 (51)
Additional malignancy apart from MM / 2 (3) / 6 (9)
Comorbidity indices (high-risk-group)
FCI>0 / 16% / 0 (0-2) / 52% / 1 (0-3)
HCT-CI >1 / 26 % / 0 (0-5) / 51 % / 2 (0-10)
CCI >5 / 21 % / 4 (2-10) / 39 % / 5 (2-12)
KF>2 / 19 % / 1 (0-3) / 42 % / 2 (0-3)
SI >1 / 24 % / 1 (0-4) / 28 % / 1 (0-4)
Supplementary Table 3. Organ function and comorbidity scores according high-dose - vs. standard-therapy
Abbreviation: eGFR: estimated glomerular filtration rate; KPS: Karnofsky-Performance status; FCI: Freiburger comorbidity index, HCT-CI:
Hematopoetic cell transplantation-specific comorbidity index, CCI: Charlson-Comorbidity-Index, KF: Kaplan-Feinstein Index, high-risk-groups:
>median score points.
Supplementary Table 4. Patient characteristics within different CKD stages
eGFR ≥ 60ml/min/1.73m2 / CKD-stage III (n=16)
eGFR 59-30ml/min/1.73m2 / eGFR-stage IV-V (n=12)
eGFR<30ml/min/1.73m2
Characteristics / n (%) / median (range) / n (%) / median (range) / n (%) / median (range)
Age (year) / 58 (27-83) / 60 (37-78) / 69 (58-76)
KPS (%) / 90 (40-100) / 80 (50-100) / 70 (50-90)
BMI (kg/m2) / 24 (15-36) / 24 (17-27) / 24 (19-30)
Durie&Salmon stage
II / III / 91 (92) / 14 (88) / 11 (92)
A : B / 95 (96) : 4 (4) / 11 (69) : 5 (31) / 2 (17): 10 (83)
ISS stage
II / III / 10 (17) : 8 (14) / 1 (10) : 6 (60) / 0 : 3 (43)
ß2-microglobulin (mg/dl) / 2.8 (1.1-10.1) / 6.3 (1.4-19.2) / 10.3 (2.5-23)
PC BM-Infiltration rate (%) / 30 (0-90) / 50 (10-70) / 30 (10-50)
Cytogenetics (FISH)
Deletion 13q14 / 14 (30) / 1 (20) / 1 (25)
Comorbidities
Lung disease, moderate-severe / 13 (13) / 5 (3) / 5 (42)
Cardiac impairment, moderate-severe / 18 (18) / 3 (19) / 4 (33)
Hypertension, moderate-severe / 13 (13) / 3 (19) / 5 (42)
Hepatic impairment, moderate-severe / 2 (2) / 3 (19) / 2 (17)
Pain despite of therapy / 49 (49) / 3 (19) / 7 (58)
Diabetes mellitus / 10 (10) / 2 (13) / 1 (8)
Additional malignancy apart from MM / 3 (3) / 3 (19) / 2 (17)
CI high-risk group
FCI >0 / 24 (24) / 0 (0-2) / 9 (56) / 1 (0-1) / 11 (92) / 2 (1-3)
HCT-CI >1 / 26 (26) / 1 (0-6) / 11 (69) / 2 (0-7) / 12 (100) / 5 (2-10)
CCI >5 / 22 (22) / 4 (2-9) / 6 (38) / 5 (3-10) / 10 (83) / 8 (5-12)
KF >2 / 19 (19) / 1 (0-3) / 9 (56) / 3 (0-3) / 11 (92) / 3 (3-3)
SI>1 / 20 (20) / 1 (0-4) / 6 (38) / 1 (0-3) / 7 (58) / 2 (0-4)
Standard therapy : auto PBSCT / 43 (43) : 56 (57) / 12 (75) : 4 (25) / 10 (83) : 2 (17)
Abbreviation: KPS: Karnofsky-Performance Status; BMI: Body Mass Index, ISS: International Staging System, PC BM-Infiltration rate: plasma cell bone marrow infiltration rate, eGFR: estimated glomerular filtration rate, CKD: chronic kidney disease stages according to K/DOQI guidelines defined by MDRD: Modification of Diet in Renal Disease: estimated GFR (ml/min/1.73m²)= 186 x (serum creatinine level [in milligrams per deciliter])-1.154 x (age [in years])-0.203 x (0.742 if female, 1.21 if black), FISH: Fluorescence in situ hybridization, CI: comorbidity index; high-risk-group: >median score points, FCI: Freiburger comorbidity index, HCT-CI: Hematopoetic cell transplantation-specific comorbidity index, CCI: Charlson-Comorbidity-index, KF: Kaplan-Feinstein index; SI: Satariano index; auto-PBSCT: autologous peripheral blood stem cell transplantation.