Outcome and prognostic factors for patients who relapse after allogeneic hematopoietic stem cell transplantation.
Outcome and prognostic factors for patients who relapse after allogeneic hematopoietic stem cell transplantation.
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DOI：
10.1016/j.bbmt.2013.09.011
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发表时间：
2013-12
影响因子：
4.3
通讯作者：
Armand, Philippe
中科院分区：
文献类型：
--
作者：
Thanarajasingam, Gita;Kim, Haesook T.;Cutler, Corey;Ho, Vincent T.;Koreth, John;Alyea, Edwin P.;Antin, Joseph H.;Soiffer, Robert J.;Armand, Philippe
关键词：
疾病复发一直是异基因造血干细胞移植（HSCT）成功的主要障碍，但对复发后的相关预后因素知之甚少。我们研究了2004年至2008年期间的1080例移植患者，其中351例复发。复发后3年总生存率（prOS）为19%。复发后死亡的危险因素包括复发时间较短、HSCT时疾病风险指数较高、清髓性预处理、移植前合并症指数较高和复发前发生的移植物抗宿主病（GVHD）。重要的预后因素并不因疾病类型而异。基于此，我们可以将患者分为3组，3年prOS分别为36%、14%和3%（p<0.0001）。该评分在276例患者的历史队列中得到验证。复发后供体淋巴细胞输注或重复HSCT与prOS改善相关，复发后GVHD的发生也是如此。这些差异在考虑其他预后因素的模型中以及对复发后存活至少2个月的患者的里程碑分析中仍然显着。这项研究的结果可能有助于HSCT后复发患者的诊断和管理，以及激励旨在预防或治疗高危患者复发的临床试验的设计。
Disease relapse remains a major obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT), yet little is known about the relevant prognostic factors after relapse. We studied 1080 patients transplanted between 2004 and 2008, among whom 351 relapsed. The 3-year post-relapse overall survival (prOS) was 19%. Risk factors for mortality after relapse included shorter time to relapse, higher disease risk index at HSCT, myeloablative conditioning, high pre-transplantation co-morbidity index, and graft-versus-host disease (GVHD) occurring prior to relapse. Important prognostic factors did not vary by disease type. Based on this, we could stratify patients into 3 groups, with 3-year prOS of 36%, 14% and 3% (p<0.0001). This score was validated in a historical cohort of 276 patients. Post-relapse donor lymphocyte infusion or repeat HSCT was associated with improved prOS, as was the development of GVHD after relapse. These differences remained significant in models that accounted for other prognostic factors and in landmark analyses of patients who survived at least 2 months from relapse. The results of this study may aid with prognostication and management of patients who relapse after HSCT, as well as motivate the design of clinical trials aimed at relapse prevention or treatment in the higher-risk patients.
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影响因子：
20.3
作者：
Schmid, Christoph;Labopin, Myriam;Mohty, Mohamad
通讯作者：
Mohty, Mohamad
影响因子：
2
作者：
HARRELL, FE;LEE, KL;ROSATI, RA
通讯作者：
ROSATI, RA
影响因子：
3.2
作者：
Oran, Betul;de Lima, Marcos
通讯作者：
de Lima, Marcos
DOI：
10.1016/j.bbmt.2010.06.008
发表时间：
2010-09
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Kröger N;Bacher U;Bader P;Böttcher S;Borowitz MJ;Dreger P;Khouri I;Macapinlac HA;Olavarria E;Radich J;Stock W;Vose JM;Weisdorf D;Willasch A;Giralt S;Bishop MR;Wayne AS
通讯作者：
Wayne AS
影响因子：
4.3
作者：
Alyea, Edwin P.;DeAngelo, Daniel J.;Moldrem, Jeffrey;Pagel, John M.;Przepiorka, Donna;Sadelin, Michel;Young, James W.;Giralt, Sergio;Bishop, Michael;Riddell, Stan
通讯作者：
Riddell, Stan