The Effect of Smoking on Allogeneic Transplant Outcomes
The Effect of Smoking on Allogeneic Transplant Outcomes
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DOI：
10.1016/j.bbmt.2009.06.005
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发表时间：
2009-10-01
影响因子：
4.3
通讯作者：
Rizzo, J. Douglas
中科院分区：
文献类型：
--
作者：
Marks, David I.;Ballen, Karen;Rizzo, J. Douglas
利用国际血液和骨髓移植研究中心(CIBMTR)的数据，我们比较了非吸烟者(NS)和过去或现在吸烟者(PCS)慢性粒细胞白血病(CML)患者的移植结果。有2193例NS和625例PCS在第一个慢性期接受了匹配的同胞和非血缘同种异体移植治疗CML。我们寻找剂量效应，并确定了低剂量和高剂量吸烟组(>；10包年，>；每天1包)。结果根据已知的预后变量进行了调整，包括欧洲血液和骨髓移植组织(EBMT)的风险评分。在同胞同种异体移植受者的多因素分析中，吸烟者的复发风险(RR=1.67，P=0.003)高于NS，但剂量效应并不一致。单因素分析显示，大剂量吸烟者5年时的治疗相关死亡率(TRM)为50%，而NS组为28%，多因素分析显示RR为1.57(P=0.005)。NS组5年总存活率(OS)为68%，低剂量吸烟组为62%，高剂量吸烟组为50%(P<；.001)。吸烟对无血缘关系的捐赠者的结局没有显著影响，但人数较少。在有CML同胞异基因移植的患者中，高剂量吸烟与OS减少有关。具有详细的人口学、肺功能和生活质量数据的前瞻性研究将提高我们对这一问题的理解。
Using the Center for Internaitonal Blood and Marrow Transplant Research (CIBMTR) data, we compared the transplant outcomes of patients with chronic myelogenous leukemia (CML) who were nonsmokers (NS) and past or current smokers (PCS). There were 2193 NS and 625 PCS who received matched sibling and unrelated donor allografts for CML in first chronic phase. We looked for dose effects and identified low and high dose smoking groups (>10 pack years, >1 pack per day). Outcomes were adjusted for known prognostic variables including the European Group for Blood and Marrow Transplant (EBMT) risk score. In multivariate analyses of sibling allograft recipients, relapse risk (RR) was higher (RR = 1.67, P = .003) in smokers than NS, but the dose effects were not consistent. High-dose smokers experienced a 50% treatment-related mortality (TRM) versus 28% in the NS group at 5 years on univariate analysis, and the RR was 1.57 (P = .005) on multivariate analysis. Overall survival (OS) at 5 years was 68% in NS versus 62% in the low-dose smoking group versus 50% in the high-dose smoking group (P < .001). Smoking did not significantly affect outcomes in unrelated donor recipients, but numbers were smaller. High-dose smoking is associated with a reduction in OS in patients having sibling allografts for CML. A prospective study with detailed demographic, pulmonary function, and quality-of-life data would improve our understanding of this issue.