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

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:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85042728703&doi=10.1038%2fbmt.2017.197&partnerID=40&md5=9b40a97511b66bf4d6be795c6e77159f
Notes:	Article -- Export Date: 2 April 2018 -- Source: Scopus