Reduced mortality after allogeneic hematopoietic-cell transplantation.
Reduced mortality after allogeneic hematopoietic-cell transplantation.
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DOI：
10.1056/nejmoa1004383
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发表时间：
2010-11-25
期刊：
影响因子：
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通讯作者：
McDonald GB
中科院分区：
文献类型：
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作者：
Gooley TA;Chien JW;Pergam SA;Hingorani S;Sorror ML;Boeckh M;Martin PJ;Sandmaier BM;Marr KA;Appelbaum FR;Storb R;McDonald GB
我们检验了这样一个假设：过去十年中移植实践的变化改善了结果。为了探讨改善结果的相关性，我们分析了移植物抗宿主病以及肝、肾、肺和感染并发症的频率和严重程度。 1993-1997 年和 2003-2007 年期间，分别有 1418 名和 1148 名患者在我们中心接受了首次同种异体移植。结果指标包括这十年间的非复发死亡率、复发性恶性肿瘤、总体死亡率以及主要并发症的频率和严重程度。移植前死亡率评估 (PAM) 评分的组成部分用于回归模型，以调整移植时疾病的严重程度。在比较1993-1997年和2003-2007年期间的结果时，我们观察到在调整PAM评分的组成部分后，第-200天非复发死亡率（下降60%）、总体非复发死亡率（下降52%）、恶性肿瘤复发或进展（下降21%）和总体死亡率（下降41%）的风险在统计上显着下降。当分析仅限于接受清髓性预处理治疗的患者时，也出现了类似的结果。我们发现，更严重的 GVHD、感染（病毒、细菌和真菌）引起的疾病以及肝脏、肾脏和肺部损伤的风险在统计上显着下降。我们记录了过去十年与同种异体造血细胞移植相关的死亡风险大幅降低以及长期生存率的提高。结果的改善似乎与器官损伤、感染和严重急性 GVHD 的减少有关。
We tested the hypothesis that changes in our transplant practice have improved outcomes over the last decade. To explore correlates of improved outcomes, we analyzed the frequency and severity of graft-versus-host disease and hepatic, renal, pulmonary and infectious complications. During 1993–1997 and 2003–2007, 1418 and 1148 patients received their first allogeneic transplants at our Center. Outcome measures included non-relapse mortality, recurrent malignancy, overall mortality, and the frequency and severity of major complications across this decade. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for severity of illness at the time of transplantation. In comparing outcomes during 1993–1997 and 2003–2007, we observed statistically significant decreases in the hazards of day -200 non-relapse mortality (by 60%), overall non-relapse mortality (by 52%), relapse or progression of malignancy (by 21%), and overall mortality (by 41%), after adjusting for components of the PAM score. Similar results were seen when the analyses were confined to patients receiving myeloablative conditioning therapy. We found statistically significant declines in the risk of more severe GVHD, disease caused by infections (viral, bacterial, and fungal), and damage to the liver, kidneys, and lungs. We document a substantial reduction in the hazard of death related to allogeneic hematopoietic cell transplantation as well as improved long-term survival over the last decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD.