BACKGROUND AND OBJECTIVES: Transplant-related mortality (TRM) following allogeneic hematopoietic stem cell transplantation (HSCT) has been reported to be related to disease stage, duratiion of disease and type of donor. Furthermore, the outcome of transplants performed in the 1990s appears to be better than that of transplants done in the previous decade. The aims of this study were to determine whether these relationships still hold and whether the outcome of transplants is continuing to improve. DESIGN AND METHODS: We analyzed 1180 consecutive patients with leukemia (n=979) or other hematologic malignancies (n=201) undergoing HSCT in 4 time periods: before 1990, 1991-1995, 1996-2000, and 2001-2002. Changes during these eras include increasing patient age, more unrelated transplants, more patients with advanced disease, different graft-versus-host disease (GvHD) prophylaxis, and different management of infections. RESULTS: The actuarial 2-year transplant-related mortality (TRM) differed significantly between the transplant eras (p<0.001) with a significant interaction with disease phase (p=0.018). In patients in first remission (n=585) TRM was 34%, 25%, 21% and 6% in the four transplant eras. The reduction in TRM was less evident in patients in second remission (n=284) (37%, 35%, 30%, 25%) and absent in relapsed patients (n=311) (TRM=45%, 41%, 29%, 51%). This is a consequence of reductions in GvHD, infections and multiorgan failure among patients in remission but not among those who relapse. The actuarial 2-year survival has improved significantly in patients in first remission (54%, 66%, 72%, 78%) but not in those in second remission (38%, 46%, 52%,45%), or relapsed patients (31%, 25%, 36%, 21%). INTERPRETATION AND CONCLUSIONS: In conclusion, TRM has been significantly reduced in first remission patients, suggesting an allograft should be considered in this phase, when appropriate, without delay. There has been no improvement in survival for patients beyond first remission, due to persisting high risk of infections and organ toxicity, a possible consequence of prolonged pre-transplant chemotherapy and neutropenia.
BACKGROUND AND OBJECTIVES: Transplant-related mortality (TRM) following allogeneic hematopoietic stem cell transplantation (HSCT) has been reported to be related to disease stage, duratiion of disease and type of donor. Furthermore, the outcome of transplants performed in the 1990s appears to be better than that of transplants done in the previous decade. The aims of this study were to determine whether these relationships still hold and whether the outcome of transplants is continuing to improve. DESIGN AND METHODS: We analyzed 1180 consecutive patients with leukemia (n=979) or other hematologic malignancies (n=201) undergoing HSCT in 4 time periods: before 1990, 1991-1995, 1996-2000, and 2001-2002. Changes during these eras include increasing patient age, more unrelated transplants, more patients with advanced disease, different graft-versus-host disease (GvHD) prophylaxis, and different management of infections. RESULTS: The actuarial 2-year transplant-related mortality (TRM) differed significantly between the transplant eras (p<0.001) with a significant interaction with disease phase (p=0.018). In patients in first remission (n=585) TRM was 34%, 25%, 21% and 6% in the four transplant eras. The reduction in TRM was less evident in patients in second remission (n=284) (37%, 35%, 30%, 25%) and absent in relapsed patients (n=311) (TRM=45%, 41%, 29%, 51%). This is a consequence of reductions in GvHD, infections and multiorgan failure among patients in remission but not among those who relapse. The actuarial 2-year survival has improved significantly in patients in first remission (54%, 66%, 72%, 78%) but not in those in second remission (38%, 46%, 52%,45%), or relapsed patients (31%, 25%, 36%, 21%). INTERPRETATION AND CONCLUSIONS: In conclusion, TRM has been significantly reduced in first remission patients, suggesting an allograft should be considered in this phase, when appropriate, without delay. There has been no improvement in survival for patients beyond first remission, due to persisting high risk of infections and organ toxicity, a possible consequence of prolonged pre-transplant chemotherapy and neutropenia.
Authors: A Xhaard; R Porcher; J W Chien; R P de Latour; M Robin; P Ribaud; V Rocha; A Devergie; C Ferry; P J Martin; G Socié Journal: Leukemia Date: 2008-08-07 Impact factor: 11.528
Authors: R Parody; R Martino; R de la Cámara; A García-Noblejas; A Esquirol; I Garcia-Cadenas; T Villaescusa; D Caballero; M Rovira; F Fernandez-Avilés; F J Marquez-Malaver; I Espigado; C Castilla-Llorente; I Heras; M A Cabero; J R Cabrera; P Barba; D Valcarcel; I Sánchez-Ortega; R F Duarte; D Serrano; F Carretero; L Vazquez Journal: Bone Marrow Transplant Date: 2014-10-27 Impact factor: 5.483
Authors: Steven Z Pavletic; Shaji Kumar; Mohamad Mohty; Marcos de Lima; James M Foran; Marcelo Pasquini; Mei-Jie Zhang; Sergio Giralt; Michael R Bishop; Daniel Weisdorf Journal: Biol Blood Marrow Transplant Date: 2010-04-24 Impact factor: 5.742
Authors: Thomas Weber; Andreas Schmidberger; Kinga Ligeti; Marcus Bauer; Andreas Rosenwald; Lutz P Müller Journal: Acta Haematol Date: 2020-09-09 Impact factor: 2.195
Authors: Andrea Bacigalupo; Karen Ballen; Doug Rizzo; Sergio Giralt; Hillard Lazarus; Vincent Ho; Jane Apperley; Shimon Slavin; Marcelo Pasquini; Brenda M Sandmaier; John Barrett; Didier Blaise; Robert Lowski; Mary Horowitz Journal: Biol Blood Marrow Transplant Date: 2009-09-01 Impact factor: 5.742