Long-term prognosis for 1-year relapse-free survivors of CD34 cell-selected allogeneic hematopoietic stem cell transplantation : a landmark analysis
Cho, Christina (Weill Cornell Medicine)
Hsu, Meier (Memorial Sloan Kettering Cancer Center)
Barba, Pere (Hospital Universitari Vall d'Hebron)
Maloy, Molly A. (Memorial Sloan Kettering Cancer Center)
Avecilla, Scott T. (Memorial Sloan Kettering Cancer Center)
Barker, Juliet N. (Weill Cornell Medicine)
Castro-Malaspina, Hugo (Weill Cornell Medicine)
Giralt, Sergio A. (Weill Cornell Medicine)
Jakubowski, Ann A. (Weill Cornell Medicine)
Koehne, Guenther (Weill Cornell Medicine)
Meagher, Richard C. (Memorial Sloan Kettering Cancer Center)
O'Reilly, Richard J. (Memorial Sloan Kettering Cancer Center)
Papadopoulos, Esperanza B. (Weill Cornell Medicine)
Ponce, Doris M. (Weill Cornell Medicine)
Tamari, Roni (Weill Cornell Medicine)
van den Brink, Marcel R. M. (Weill Cornell Medicine)
Young, James (The Rockefeller University (Nova York,Estats Units d'Amèrica))
Devlin, Sean M. (Memorial Sloan Kettering Cancer Center)
Perales, Miguel-Angel (Weill Cornell Medicine)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	CD34 selection significantly improves GVHD-free survival in allogeneic hematopoietic cell transplantation (allo-HSCT). Specific information regarding long-term prognosis and risk factors for late mortality after CD34-selected allo-HSCT is lacking, however. We conducted a single-center landmark analysis in 276 patients alive without relapse 1 year after CD34-selected allo-HSCT for AML (n=164), ALL (n=33), or MDS (n=79). At 5 years' follow-up after the 1-year landmark (range 0. 03-13 years), estimated RFS was 73% and OS 76%. The 5-year cumulative incidence of relapse and NRM were 11% and 16%, respectively. In multivariate analysis, HCT-CI score ≥ 3 correlated with marginally worse RFS (HR 1. 78, 95% CI 0. 97-3. 28, p=0. 06) and significantly worse OS (HR 2. 53, 95% CI 1. 26-5. 08, p=0. 004). Despite only 24% of patients with acute GVHD within 1 year, this also significantly correlated with worse RFS and OS, with increasing grades of acute GVHD associating with increasingly poorer survival on multivariate analysis (p<0. 0001). Of 63 deaths after the landmark, GVHD accounted for 27% of deaths and was the most common cause of late mortality, followed by relapse and infection. While prognosis is excellent for patients alive without relapse 1 year after CD34-selected allo-HSCT, risks of late relapse and NRM persist, particularly due to GVHD.
Nota:	Altres ajuts: This research was supported in part by National Institutes of Health award number P01 CA23766 and NIH/NCI Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Bone marrow transplantation, Vol. 52 (october 2017) , p. 1629-1636, ISSN 1476-5365

DOI: 10.1038/bmt.2017.197
PMID: 28991247

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