Late mortality after bone marrow transplant for chronic myelogenous leukemia in the context of prior tyrosine kinase inhibitor exposure: A Blood or Marrow Transplant Survivor Study (BMTSS) report.
Late mortality after bone marrow transplant for chronic myelogenous leukemia in the context of prior tyrosine kinase inhibitor exposure: A Blood or Marrow Transplant Survivor Study (BMTSS) report.
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在先前的酪氨酸激酶抑制剂暴露的背景下，慢性粒细胞性白血病的骨髓移植后的晚期死亡率：血液或骨髓移植幸存者研究（BMTSS）报告。
作者：
研究了接受血液或骨髓移植（BMT）的慢性粒细胞白血病（CML）患者的晚期死亡率，这些患者既往接受过或未接受过酪氨酸激酶抑制剂（TKI）治疗。通过使用血液或骨髓移植存活者研究的数据，作者检查了1974年至2010年期间接受BMT的447例CML患者的晚期死亡率，条件是BMT后存活≥2年。对于生命状态信息，使用了医疗记录、国家死亡指数和Accurint数据库。标准化死亡率（SMR）采用一般人群年龄特异性、性别特异性和器官特异性死亡率计算。使用Kaplan-Meier技术和考克斯回归进行全因死亡率分析。竞争风险的累积发生率和比例子分布风险模型用于原因特异性死亡率分析。接受移植的患者在BMT前接受和未接受TKI治疗的10年总生存率分别为65.7%和73%。接受移植的患者，有和没有预先BMT TKI经历SMR分别为6.4和6.4（P = .8）;和SMR分别为11.6和8.1，对于那些有高风险的疾病（P = .2）。非CML相关死亡率的独立预测因素包括慢性移植物抗宿主病（风险比[HR]，2.8; 95% CI，1.8-4.4）和白消安/环磷酰胺处理（HR，0.5; 95% CI，0.3-0.9;参考，全身照射/环磷酰胺处理）。在整个队列中，CML相关和非CML相关死亡率的20年累积发生率分别为6%和36%。在接受和未接受BMT前TKI治疗的患者中，CML相关死亡率（HR，1.0; 95% CI，0.1-12.6）和非CML相关死亡率（HR，1.3; 95% CI，0.6-3.1）相当。接受移植（伴或不伴预BMT TKI）的CML患者的晚期死亡率相似，表明在TKI不耐受或不依从的情况下可以考虑同种异体BMT。BMT后非CML相关死亡的预防可有利地影响长期生存。
Late mortality was investigated in patients with chronic myelogenous leukemia (CML) who underwent blood or bone marrow transplant (BMT) with or without prior tyrosine kinase inhibitor (TKI) therapy. By using data from the Blood or Marrow Transplant Survivor Study, the authors examined late mortality in 447 patients with CML who underwent BMT between 1974 and 2010, conditional on surviving ≥2 years post-BMT. For vital status information, the medical records, the National Death Index, and the Accurint database were used. Standardized mortality ratios (SMRs) were calculated using general population age-specific, sex-specific, and calendar-specific mortality rates. Kaplan-Meier techniques and Cox regression were used for all-cause mortality analyses. Cumulative incidence and proportional subdistribution hazards models for competing risks were used for cause-specific mortality analyses. The 10-year overall survival rate was 65.7% and 73% for those who underwent transplant with and without pre-BMT exposure to TKI therapy, respectively. Patients who underwent transplant with and without pre-BMT TKI experienced SMRs of 6.4 and 6.4, respectively (P = .8); and the SMRs were 11.6 and 8.1, respectively, for those with high-risk disease (P = .2). Independent predictors of non–CML-related mortality included chronic graft-versus-host disease (hazard ratio [HR], 2.8; 95% CI, 1.8–4.4) and busulfan/cyclophosphamide conditioning (HR, 0.5; 95% CI, 0.3–0.9; reference, total body irradiation/cyclophosphamide conditioning). The 20-year cumulative incidence of CML-related and non–CML-related mortality was 6% and 36%, respectively, for the entire cohort. Both CML-related mortality (HR, 1.0; 95% CI, 0.1–12.6) and non–CML-related mortality (HR, 1.3; 95% CI, 0.6–3.1) were comparable for those with and without pre-BMT TKI therapy. The similar late mortality experienced by patients with CML who undergo transplantation with or without pre-BMT TKIs suggests that allogeneic BMT can be considered in the context of TKI intolerance or nonadherence. The prevention of post-BMT non–CML-related mortality could favorably affect long-term survival.
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