Analysis of Morbidity and Mortality Among Hematopoietic Cell Transplantation Surv

造血细胞移植存活率及死亡率分析

• 批准号: 8641672
• 负责人: Eric Jessen Chow
• 金额: $ 8.54万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8641672
• 关键词: Affect; Agreement; Algorithms; Allogenic; Autologous; Award; Cancer Patient; Cancer Survivor; Cardiopulmonary; Cardiovascular Diseases; Cessation of life; Chronic; Clinic Visits; Complement; Data; Data Set; Data Sources; Death Records; Disease; Event; Fred Hutchinson Cancer Research Center; Future; General Population; Guidelines; Health; Hospitals; Incidence; Individual; Institution; Late Effects; Link; Long-Term Survivors; Lung; Malignant - descriptor; Malignant Neoplasms; Measures; Medical Records; Methodology; Methods; Morbidity - disease rate; Non-Malignant; Outcome; Patient Self-Report; Population; Population Control; Population Study; Pulmonary Heart Disease; Radiation therapy; Recurrent disease; Relative Risks; Research; Research Personnel; Risk; Risk Factors; Sample Size; Sensitivity and Specificity; Source; State Hospitals; Stem cells; Survivors; Time; Transplantation; Validation; Washington; Whole-Body Irradiation; Work; adverse outcome; cancer diagnosis; cancer risk; chemotherapy; chronic graft versus host disease; cohort; data registry; design; experience; follow-up; graft vs host disease; hematopoietic cell transplantation; interest; modifiable risk; mortality; neoplasm registry; population based; public health relevance; response; screening

DESCRIPTION (provided by applicant): With the increasing use of hematopoietic cell transplantation (HCT) and the corresponding increase in the number of long-term survivors, there is an important need to better characterize causes of late morbidity and mortality in this population beyond description of primary disease relapse and graft vs. host disease (GVHD). Using available population-based hospital discharge and death registry data, our existing work has elucidated the magnitude of serious cardiovascular disease among long-term (e2-yr) transplant survivors and is leading to a better understanding of associated pre-HCT and HCT-related risk factors. We now propose to extend this methodology to comprehensively examine all other important health outcomes in this population of e2-yr HCT survivors who are Washington State (WA) residents and treated at the Fred Hutchinson Cancer Research Center (FHCRC) from 1985-2011 (n=2096, 53% allogeneic). In particular, we will focus on serious late pulmonary and infectious complications and 2nd cancers, which along with cardiovascular disease have been identified as leading causes of non-relapse related mortality in prior studies. Pre-HCT and HCT-related exposures from this cohort will be linked to state hospital discharge, death, and cancer registries from the concurrent time period. This will allow us to: 1) compare outcome rates in HCT survivors with those derived from the general population as well as a non-HCT cancer population matched on original cancer diagnosis; 2) examine the association of both pre-HCT and HCT-related exposures with our outcomes of interest. The proposed study takes advantage of existing datasets and one of the world's largest HCT cohorts, uses population-based methods, and circumvents survival and response biases that have affected many existing HCT studies dependent on patient self-report and/or long-term follow-up clinic visits. A cohort of affected long- term survivors also will be identified for whom secondary validation of outcomes via direct medical record review and more in-depth assessment of potential modifiable risk factors can occur. This proposal incorporates methodology and combines data sources not previously used by HCT researchers, including those from FHCRC, and has potential to greatly extend the understanding of the entire spectrum of health outcomes that occur in this at-risk cancer population. Overall, these results may then ultimately influence post-HCT screening guidelines, including the design of risk prediction algorithms to identify those who will be at increased risk for late adverse outcomes. Findings also will be directly relevant to the larger population of cancer patients who often receive similar treatment exposures.

描述（由申请人提供）：随着造血细胞移植（HCT）的越来越多的使用以及长期幸存者数量的相应增加，在该人群中的晚期发病率和死亡率的特征是，超出描述原发性疾病复发和移植物与宿主疾病（GVHD）的重要原因。使用基于人群的医院出院和死亡注册表数据，我们现有的工作阐明了长期（E2-AR）移植幸存者中严重心血管疾病的严重程度，并使人们对相关的HCT和与HCT相关的危险因素有了更好的了解。现在，我们建议扩展这种方法，以全面检查华盛顿州（WA）居民的E2-yr HCT幸存者人群中的所有其他重要健康结果，并在1985- 2011年的Fred Hutchinson Cancer Research Center（FHCRC）接受治疗（n = 2096，53％）。特别是，我们将重点关注严重的晚期肺和感染并发症和第二癌，在先前的研究中，它们与心血管疾病一起被确定为与非释放相关死亡率的主要原因。该队列中的HCT和HCT相关的与HCT相关的暴露将与并发时间段的州医院出院，死亡和癌症登记处有关。这将使我们能够：1）将HCT幸存者的结果率与从普通人群中得出的结果以及在原始癌症诊断中匹配的非HCT癌种群； 2）检查与HCT和HCT相关的暴露与我们感兴趣的结果的关联。拟议的研究利用了现有的数据集和世界上最大的HCT队列之一，使用基于人群的方法，并规避了依赖于患者自我报告和/或长期随访诊所就诊的许多现有HCT研究的生存和反应偏见。还将确定一系列受影响的长期幸存者通过直接医疗记录审查对结局的次要验证，并可能对潜在的可修改风险因素进行更多深入评估。该提案结合了方法论，并结合了HCT研究人员以前未使用的数据源，包括来自FHCRC的研究源，并且有可能大大扩展对这种高危癌症种群中发生的整个健康结果的理解。总体而言，这些结果可能最终会影响HCT筛查后的指南，包括设计风险预测算法的设计，以识别那些将会增加患有晚期不良结果风险的人。发现也将与较大的癌症患者人群直接相关，这些癌症患者经常接受类似的治疗暴露。