Risk Score for Outcome After Allogeneic Hematopoietic Stem Cell Transplantation A Retrospective Analysis
Por:
Gratwohl, A, Stern, M, Brand, R, Apperley, J, Baldomero, H, de Witte, T, Dini, G, Rocha, V, Passweg, J, Sureda, A, Tichelli, A, Niederwieser, D
Publicada:
15 oct 2009
Resumen:
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.
Filiaciones:
Gratwohl, A:
Univ Basel, Univ Hosp, Dept Hematol, CH-4031 Basel, Switzerland
Stern, M:
Univ Basel, Univ Hosp, Dept Hematol, CH-4031 Basel, Switzerland
Brand, R:
Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
Apperley, J:
Hammersmith Hosp, Dept Hematol, London, England
Baldomero, H:
Univ Basel, Univ Hosp, Dept Hematol, CH-4031 Basel, Switzerland
de Witte, T:
Radboud Univ Nijmegen Med Ctr, Dept Hematol, Nijmegen, Netherlands
Dini, G:
Inst G Gaslini, Dept Pediat Hematol & Oncol, Genoa, Italy
Rocha, V:
Hop St Louis, Dept Hematol, Paris, France
Passweg, J:
Univ Hosp Geneva, Dept Internal Med, Div Hematol, Geneva, Switzerland
Sureda, A:
Santa Creu & St Pau Hosp, Clin Hematol Unit, Barcelona, Spain
Niederwieser, D:
Univ Hosp, Div Hematol & Oncol, Leipzig, Germany
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