Risk Score for Outcome After Allogeneic Hematopoietic Stem Cell Transplantation A Retrospective Analysis
Risk Score for Outcome After Allogeneic Hematopoietic Stem Cell Transplantation A Retrospective Analysis
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DOI：
10.1002/cncr.24531
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发表时间：
2009-10-15
期刊：
影响因子：
6.2
通讯作者：
Niederwieser, Dietger
中科院分区：
文献类型：
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作者：
Gratwohl, Alois;Stern, Martin;Niederwieser, Dietger
背景技术背景：研究了欧洲血液和骨髓移植组风险评分（先前为慢性髓性白血病建立）是否可用于预测一般血液病异基因造血干细胞移植（HSCT）后的结局。方法：患者年龄、疾病分期、从诊断到移植的时间间隔、供体类型和供体-受体性别组合用于建立0 - 7分的评分。在1980年至2005年期间，在56，505名患者中测试了其有效性，其中33，113名（58%）男性，23，392名女性，中位年龄33岁（范围，0.5-77岁），接受同种异体HSCT治疗血液学疾病。研究结果：整个队列的5年生存概率从风险评分0的71%（95%置信区间[CI]，69%-73%）（75%，95% CI，72%-78%，最近时间队列）降至24%（95% CI，21%-27%，风险评分6和7; 25%，95% CI，22%-29%，最近队列）。移植相关死亡率从风险评分为0（11%，95% CI，9%-13%，最近队列）的15%（95% CI，14%-17%）增加至整个队列风险评分为6和7（95% CI，44%-50%）的47%（45%，95% CI，42%-48%，最近队列）。风险评分在所有疾病类别中，在所有时间段内都是预测性的，并且不会因移植技术而改变。结论：五个明确的移植前患者和供体特征提供了一个合理的异基因造血干细胞移植的风险估计。该风险评分可以为移植和非移植策略之间的决策提供依据。Cancer 2009;115：4715-26. (C)2009年美国癌症协会。
BACKGROUND: It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general. METHODS: Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5-77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005. RESULTS: Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%-73%) for risk score 0 for the whole cohort (75%, 95% Cl, 72%-78% for the most recent time cohort) to 24% (95% Cl, 21%-27% for risk score 6 and 7; 25%, 95% Cl, 22%-29% most recent cohort). Transplant-related mortality increased from 15% (95% Cl, 14%-17%) for risk score O (11%, 95% Cl, 9%-13%, most recent cohort) to 47% with risk score 6 and 7 (95% Cl, 44%-50%) for the whole cohort (45%, 95% Cl, 42%-48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques. CONCLUSIONS: Five well-defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies. Cancer 2009;115:4715-26. (C) 2009 American Cancer Society.