Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Nov 25;363(22):2091-101.
doi: 10.1056/NEJMoa1004383.

Reduced mortality after allogeneic hematopoietic-cell transplantation

Ted A Gooley  1 , Jason W Chien, Steven A Pergam, Sangeeta Hingorani, Mohamed L Sorror, Michael Boeckh, Paul J Martin, Brenda M Sandmaier, Kieren A Marr, Frederick R Appelbaum, Rainer Storb, George B McDonald
Affiliations

Reduced mortality after allogeneic hematopoietic-cell transplantation

Ted A Gooley et al. N Engl J Med. .

Abstract

Background: Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation.

Methods: We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation.

Results: In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs.

Conclusions: We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Probability of non-relapse mortality (NRM) by day 200 (upper panel) and overall survival (lower panel) during two time periods. Patients alive beyond seven years are censored at 7 years for graphical purposes only.
Figure 2
Figure 2
Display of daily total serum bilirubin (top panel) and serum creatinine (lower panel) values from day 0 to day 100 in mg/dL, during two eras. The lines represent fitted cubic spline curves of the observed data. Conversion to SI units: For total serum bilirubin, 1 mg/dL=17.1 μmol/L and for serum creatinine, 1 mg/dL=88.4 μmol/L.
Figure 3
Figure 3
Distribution of the overall grade of acute GVHD and the stage of liver and gastrointestinal GVHD in two eras.
See this image and copyright information in PMC

Comment in

References

    1. Appelbaum FR, Forman SJ, Negrin RS, Blume KG. Thomas’ Hematopoietic Cell Transplantation. 4. Oxford, UK: Wiley-Blackwell Publishing; 2009.
    1. McDonald GB, Slattery JT, Bouvier ME, et al. Cyclophosphamide metabolism, liver toxicity, and mortality following hematopoietic stem cell transplantation. Blood. 2003;101:2043–8. - PubMed
    1. Hingorani SR, Guthrie K, Batchelder A, et al. Acute renal failure after myeloablative hematopoietic cell transplant: incidence and risk factors. Kidney International. 2005;67:272–7. - PubMed
    1. Clark JG, Madtes DK, Martin TR, Hackman RC, Farrand AL, Crawford SW. Idiopathic pneumonia after bone marrow transplantation: cytokine activation and lipopolysaccharide amplification in the bronchoalveolar compartment. Critical Care Medicine. 1999;27:1800–6. - PubMed
    1. Patriarca F, Skert C, Sperotto A, et al. Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation. Bone Marrow Transplantation. 2004;33:751–8. - PubMed

Publication types

MeSH terms