Increasing chimerism after allogeneic stem cell transplantation is associated with longer survival time.
Increasing chimerism after allogeneic stem cell transplantation is associated with longer survival time.
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DOI：
10.1016/j.bbmt.2014.04.003
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发表时间：
2014-08
影响因子：
4.3
通讯作者：
Andersson, Borje S.
中科院分区：
文献类型：
--
作者：
Tang, Xiaowen;Alatrash, Gheath;Ning, Jing;Jakher, Haroon;Stafford, Patricia;Zope, Madhushree;Shpall, Elizabeth J.;Jones, Roy B.;Champlin, Richard E.;Thall, Peter F.;Andersson, Borje S.
同种异体干细胞移植（allo-SCT）后的供体嵌合通常用于预测总生存（OS）和无病生存（DFS）时间。由于在异基因 SCT 后观察到嵌合现象一次或多次，而不是在基线时观察到，如果嵌合现象实际上与 OS 或 DFS 相关，则疾病进展或死亡的发生会在信息上审查（终止）观察到的嵌合过程。这违反了生存分析标准统计回归方法的假设，可能导致有偏差的结论。为了评估纵向异基因 SCT 供体嵌合过程与 OS 或 DFS 之间的关联，我们分析了 195 名急性髓性白血病 (n=157) 或骨髓增生异常综合征 (n=38) 患者的数据，这些患者在接受氟达拉滨/静脉注射白消安减毒预处理方案后，在异基因 SCT 后获得完全缓解。中位随访时间为 31 个月（范围：1.1-105 个月）。拟合的联合纵向生存时间模型显示，完整（100%）供体嵌合的二元指标和供体 T 细胞百分比的增加均与较长的 OS 显着相关，而供体 T 细胞百分比的降低与较短的 OS 高度显着相关。我们的分析说明了将重复的同种异体 SCT 后嵌合测量与 OS 和 DFS 联合建模为单独的纵向过程的有用性，以估计它们的关系。
Donor chimerism following allogeneic stem cell transplantation (allo-SCT) commonly is used to predict overall survival (OS) and disease-free survival (DFS) time. Because chimerism is observed at one or more times after allo-SCT, and not at baseline, if chimerism is in fact associated with OS or DFS then the occurrence of either disease progression or death informatively censors (terminates) the observed chimerism process. This violates the assumptions underlying standard statistical regression methods for survival analysis, which may lead to biased conclusions. To assess association between the longitudinal post-allo-SCT donor chimerism process and OS or DFS, we analyzed data from 195 patients with acute myelogenous leukemia (n=157) or myelodysplastic syndrome (n=38) who achieved complete remission after allo-SCT following a reduced-toxicity conditioning regimen of fludarabine/intravenous busulfan. Median follow-up was 31 months (range, 1.1–105 months). Fitted joint longitudinal-survival time models showed that a binary indicator of complete (100%) donor chimerism, and increasing percent donor T-cells, both were significantly associated with longer OS, while decreasing percent donor T-cells was highly significantly associated with shorter OS. Our analyses illustrate the usefulness of modeling repeated post-allo-SCT chimerism measurements as individual longitudinal processes jointly with OS and DFS in order to estimate their relationships.
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影响因子：
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作者：
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