Value of the pretransplant evaluation in predicting toxic day-100 mortality among blood stem-cell and bone marrow transplant recipients
Value of the pretransplant evaluation in predicting toxic day-100 mortality among blood stem-cell and bone marrow transplant recipients
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DOI：
10.1200/jco.1998.16.12.3796
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发表时间：
1998-12-01
影响因子：
45.3
通讯作者：
Mangan, KF
中科院分区：
文献类型：
--
作者：
Goldberg, SL;Klumpp, TR;Mangan, KF
目的：为了确定阀的移植前研究在预测100天nonrecurrence毒性死亡率以下high-dose therapy.Patients和方法：383个连续的造血干细胞移植进行了回顾性分析，注意毒性死亡率和移植前因素。单变量对数秩分析用于产生单个因素的最显著临界值。多变量分析采用考克斯比例风险回归确定的因素独立预测早期中毒death.Results：非复发毒性死亡前100天发生在23 383（6.0%）移植受体。单变量分析显示，与中毒性死亡风险增加相关的因素包括：1秒用力呼气量（FEV 1）小于预测值的78%。（P = .0002），同种异体与自体移植（P = 0.0003），一氧化碳扩散能力小于预测值的52%（P = .002），血清肌酐浓度大于1.1 mg/dL（P = .003），东部肿瘤协作组体力状态大于O（P = .006），包含全身照射的准备方案与单独化疗相比（P = 0.006），骨髓与造血干细胞（P = .01），血清ALT大于50 IU/L（P = .02），血液系统疾病与实体瘤的诊断（P = 0.06），血清胆红素水平大于1.1 mg/dL（P = 0.08），左心室射血分数（P = 0.09）和生长因子使用（P = 0.09）。在多变量模型中，（相对危险度，4.2），FEV 1（相对风险，4.5），性能状态（相对危险度，3.7），血清肌酐（相对危险度，3.8）和血清胆红素（相对危险度，3.7）是早期中毒死亡率的独立预测因子。移植前评估是一个有用的工具，以确定患者在高剂量治疗后的早期毒性死亡的风险。(C)1998年，美国临床肿瘤学会。
Purpose: To determine the valve of pretransplant studies in predicting day 100 nonrelapse toxic mortality following high-dose therapy.Patients and Methods: A retrospective review of 383 consecutive hematopoietic stem-cell transplants was performed with attention to toxic mortality and pretransplant factors. Univariate log-rank analysis wets used to yield the most significant cut-off values for individual factors. Multivariate analysis using Cox proportional hazards regression determined factors independently predictive of early toxic death.Results: Nonrelapse toxic mortality before day 100 occurred in 23 of 383 (6.0%) transplant recipients. Factors associated with an increased risk of toxic death by univariate analysis included forced expiratory volume in 1 second (FEV1) less than 78% of predicted (P = .0002), allogeneic versus autologous transplant (P = .0003), diffusion capacity of carbon monoxide less than 52% of predicted (P = .002), serum creatinine concentration greater than 1.1 mg/dL (P = .003), Eastern Cooperative Oncology Group performance status greater than O (P = .006), preparative regimen containing total-body irradiation versus chemotherapy alone (P = .006), marrow verses blood stem cell (P = .01), serum ALT greater than 50 IU/L (P = .02), diagnosis of hematologic disorder versus solid tumor (P = .06), serum bilirubin level greater than 1.1 mg/dL (P = .08), left ventricular ejection fraction (P = .09), and growth factor use (P = .09). In the multivariate model, transplant type (relative risk, 4.2), FEV1 (relative risk, 4.5), performance status (relative risk, 3.7), serum creatinine (relative risk, 3.8), and serum bilirubin (relative risk, 3.7) were found to be independent predictors of early toxic mortality.Conclusion: The pretransplant evaluation is a useful tool to identify patients at risk for early toxic mortality following high-dose therapy. (C) 1998 by American Society of Clinical Oncology.