The impact of toxicities on first-year outcomes after ex vivo CD34(+)-selected allogeneic hematopoietic cell transplantation in adults with hematologic malignancies Journal Article
| Authors: | Kosuri, S.; Herrera, D. A.; Scordo, M.; Shah, G. L.; Cho, C.; Devlin, S. M.; Maloy, M. A.; Nieves, J.; Borrill, T.; Carlow, D. C.; Avecilla, S. T.; Meagher, R. C.; O'Reilly, R. J.; Papadopoulos, E. B.; Jakubowski, A. A.; Koehne, G.; Gyurkocza, B.; Castro-Malaspina, H.; Shaffer, B. C.; Tamari, R.; Giralt, S. A.; Perales, M. A. |
| Article Title: | The impact of toxicities on first-year outcomes after ex vivo CD34(+)-selected allogeneic hematopoietic cell transplantation in adults with hematologic malignancies |
| Abstract: | Factors that impact first-year morbidity and mortality in adults undergoing myeloablative allogeneic hematopoietic cell transplantation with ex vivo CD34+ selection have not been previously reported. We assessed all toxicities ≥ grade 3 from the start of conditioning to date of death, relapse, or last contact in 200 patients during the first year after transplantation, identifying 1885 individual toxicities among 17 organ-based toxicity groups. The most prevalent toxicities in the first year were of infectious, metabolic, hematologic, oral/gastrointestinal, hepatic, cardiac, and pulmonary etiologies. Renal complications were minimal. Grades II to IV and III and IV acute GVHD at day 100 were 11.5% and 3%, respectively. In separate multivariate models, cardiovascular, hematologic, hepatic, neurologic, pulmonary, and renal toxicities negatively impacted nonrelapse mortality (NRM) and overall survival during the first year. A higher-than-targeted busulfan level, patient cytomegalovirus seropositivity, and an Hematopoietic Cell Transplantation–Specific Comorbidity Index of ≥3 were associated with increased risk of NRM and all-cause death. Ex vivo CD34+ selection had a favorable 1-year OS of 75% and NRM of 17% and a low incidence of sinusoidal obstruction syndrome. These data establish a benchmark to focus efforts in reducing toxicity burden while improving patient outcomes. © 2017 The American Society for Blood and Marrow Transplantation |
| Keywords: | t cell depletion; toxicities; allogeneic hematopoietic cell transplantation; ex vivo cd34 selection |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 23 |
| Issue: | 11 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2017-11-01 |
| Start Page: | 2004 |
| End Page: | 2011 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2017.07.012 |
| PROVIDER: | scopus |
| PUBMED: | 28733264 |
| PMCID: | PMC7376603 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2017 -- Source: Scopus |
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