Long-term prognosis for 1-year relapse-free survivors of CD34+ cell-selected allogeneic hematopoietic stem cell transplantation: A landmark analysis Journal Article


Authors: Cho, C.; Hsu, M.; Barba, P.; Maloy, M. A.; Avecilla, S. T.; Barker, J. N.; Castro-Malaspina, H.; Giralt, S. A.; Jakubowski, A. A.; Koehne, G.; Meagher, R. C.; O'Reilly, R. J.; Papadopoulos, E. B.; Ponce, D. M.; Tamari, R.; van den Brink, M. R. M.; Young, J. W.; Devlin, S. M.; Perales, M. A.
Article Title: Long-term prognosis for 1-year relapse-free survivors of CD34+ cell-selected allogeneic hematopoietic stem cell transplantation: A landmark analysis
Abstract: CD34+ cell selection significantly improves GvHD-free survival in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, specific information regarding long-term prognosis and risk factors for late mortality after CD34+ cell-selected allo-HSCT is lacking. We conducted a single-center landmark analysis in 276 patients alive without relapse 1 year after CD34+ cell-selected allo-HSCT for AML (n=164), ALL (n=33) or myelodysplastic syndrome (n=79). At 5 years' follow-up after the 1-year landmark (range 0.03-13 years), estimated relapse-free survival (RFS) was 73% and overall survival (OS) 76%. The 5-year cumulative incidence of relapse and non-relapse mortality (NRM) were 11% and 16%, respectively. In multivariate analysis, Hematopoietic Cell Transplantation Comorbidity Index score≤3/43 correlated with marginally worse RFS (hazard ratio (HR) 1.78, 95% confidence interval (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. Although prognosis is excellent for patients alive without relapse 1 year after CD34+ cell-selected allo-HSCT, risks of late relapse and NRM persist, particularly due to GvHD. © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
Journal Title: Bone Marrow Transplantation
Volume: 52
Issue: 12
ISSN: 0268-3369
Publisher: Nature Publishing Group  
Date Published: 2017-12-01
Start Page: 1629
End Page: 1636
Language: English
DOI: 10.1038/bmt.2017.197
PROVIDER: scopus
PMCID: PMC5718946
PUBMED: 28991247
DOI/URL:
Notes: Article -- Export Date: 2 April 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Meier Hsu
    104 Hsu
  2. Sergio Andres Giralt
    516 Giralt
  3. Doris Ponce
    129 Ponce
  4. Miguel-Angel Perales
    365 Perales
  5. Juliet N Barker
    224 Barker
  6. Guenther Koehne
    174 Koehne
  7. James W Young
    250 Young
  8. Richard O'Reilly
    468 O'Reilly
  9. Molly Anna Maloy
    123 Maloy
  10. Sean McCarthy Devlin
    288 Devlin
  11. Christina Cho
    36 Cho
  12. Roni Tamari
    75 Tamari
  13. Richard Charles Meagher
    38 Meagher