Validation of the Revised Pretransplant Assessment of Mortality Score in Patients with Acute Myelogenous Leukemia Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.
Validation of the Revised Pretransplant Assessment of Mortality Score in Patients with Acute Myelogenous Leukemia Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.
复制标题
DOI：
10.1016/j.bbmt.2018.05.021
复制
发表时间：
2018-09-01
期刊：
影响因子：
--
通讯作者：
Schetelig, Johannes
中科院分区：
文献类型：
--
作者：
Middeke, Jan M;Kollinger, Frederike;Schetelig, Johannes
尽管最近取得了进展，异基因造血干细胞移植（allo-HSCT）仍然伴随着高发病率和死亡率。已经开发了几种评分来预测allo-HSCT后的结果。最近修订的移植前死亡率评估（PAM）评分基于患者年龄、供体类型、疾病风险、患者和供体的巨细胞病毒（CMV）血清状态以及1秒用力呼气量（FEV 1）。本研究的目的是分析PAM评分在一个独立的大型急性髓性白血病（AML）患者队列中的预测能力。我们选择了在德累斯顿大学医院接受首次allo-HSCT的成人AML患者，该医院是一家拥有大型移植项目的三级护理医院。纳入了2003年1月1日至2015年7月1日期间接受治疗的所有成人患者。如前所述计算PAM评分。分析allo-HSCT后的总生存期（OS）、累积复发率（CIR）和非复发死亡率（NRM）。选择年龄、AML类型、性别匹配、CMV匹配、供体类型、欧洲白血病净风险分类、预处理类型、疾病分期和PAM评分作为多变量考克斯回归分析的先验连续变量。共有544例患者符合入选标准。患者年龄中位数为57岁。中位随访时间为47个月（范围：1 - 161个月），整个队列在4年时的估计OS为43%，CIR为30%，NRM为31%。PAM评分为0的患者4年OS的概率为65%，PAM评分为1的患者为52%，PAM评分为2的患者为33%，PAM评分为3的患者为22%（P
Despite recent advances, allogeneic hematopoietic stem cell transplantation (allo-HSCT) continues to be accompanied by a high rate of morbidity and mortality. Several scores have been developed to predict outcome after allo-HSCT. The recently revised Pretransplant Assessment of Mortality (PAM) score is based on patient age, donor type, disease risk, cytomegalovirus (CMV) serostatus of patient and donor, and forced expiratory volume in 1 second (FEV1). The aim of this study was to analyze the predictive power of the PAM score in an independent large cohort of patients with acute myelogenous leukemia (AML). We selected adult patients with AML who underwent a first allo-HSCT at the University Hospital of Dresden, a tertiary care hospital with a large transplantation program. All adult patients treated between January 1, 2003, and July 1, 2015, were included. The PAM score was calculated as described previously. Overall survival (OS), cumulative incidence of relapse (CIR), and nonrelapse mortality (NRM) after allo-HSCT were analyzed. Age, AML type, sex match, CMV match, donor type, European Leukemia Net risk classification, type of conditioning, disease stage, and PAM score as a continuous variable were selected a priori for multivariate Cox regression analyses. A total of 544 patients met the inclusion criteria. The median patient age was 57 years. With a median follow-up of 47 months (range, 1 to 161 months), the estimated OS for the whole cohort at 4 years was 43%, with a CIR of 30% and an NRM of 31%. The probability of OS at 4 years was 65% for patients with a PAM score of 0, 52% in those with a PAM score of 1, 33% in those with a PAM score of 2, and 22% in those with a PAM score of 3 (P