Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time
Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time
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DOI：
10.1038/sj.bmt.1705140
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发表时间：
2005-11-01
影响因子：
4.8
通讯作者：
Cordonnier, C
中科院分区：
文献类型：
--
作者：
Gratwohl, A;Brand, R;Cordonnier, C
我们分析了14403例来自HLA相同同胞的早期白血病移植患者的大型同质组，并在四个时间队列中报告给EBMT：1980-1989（24%），1990-1994（26%），1995-1998（30%）和1999-2001（20%）。我们关注的是感染导致的死亡。终点为生存率、复发死亡和移植相关死亡率（TRM），TRM又细分为移植物抗宿主病（GvHD）（1315例患者; 25%的死亡）、感染（597例患者; 11%的死亡）或“其他”原因（1875例患者; 34%的死亡）。5年生存率从第一组的52%增加到第三组的62%（P < 0.05），TRM从36%下降到26%（P < 0.05），这是由于感染死亡率降低（P < 0.001）。GvHD、“其他”原因和复发没有改善。细菌的相对比例（217例患者; 36%），病毒（183例患者; 31%），真菌（166例患者; 28%）或寄生虫（32例患者; 5%）作为感染性死亡的原因（5年累积死亡率分别为1.8%、1.6%、1.4%和>= 0.3%，感染死亡的中位时间（3个月（范围0-158个月））没有变化。感染导致的死亡已显著减少，但它仍然是HSCT后的持续风险，并提请注意中性粒细胞减少症初始期之后的时间。
We analysed a large homogeneous group of 14 403 patients transplanted for early leukaemia from an HLA-identical sibling and reported to the EBMT in four time cohorts: 1980-1989 (24%), 1990-1994 (26%), 1995-1998 (30%) and 1999-2001 (20%). We focused on death from infection. End points were survival, death from relapse and transplant-related mortality (TRM), which was subdivided into death from graft-versus-host disease (GvHD) (1315 patients; 25% of deaths), infection (597 patients; 11% of deaths) or 'other' causes (1875 patients; 34% of deaths). Survival increased from 52% at 5 years in the first to 62% in the third cohort (P < 0.05) and TRM decreased from 36 to 26% (P < 0.05) due to a reduction in death from infection (P < 0.001). GvHD, 'other' causes and relapse did not improve. The relative proportions of bacteria (217 patients; 36%), viruses (183 patients; 31%), fungi (166 patients; 28%) or parasites (32 patients; 5%) as cause of infectious death (cumulative incidence of death at 5 years 1.8, 1.6, 1.4 and >= 0.3%, respectively) and median time to death from infections (3 months (range 0-158 months)) did not change. Death from infections has been reduced significantly, but it still represents an ongoing risk after HSCT and draws attention to the time beyond the initial period of neutropenia.