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Comparative Study
. 2011 Mar 1;29(7):805-13.
doi: 10.1200/JCO.2010.32.5001. Epub 2011 Jan 10.

Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made?

John T Horan  1 , Brent R Logan, Manza-A Agovi-Johnson, Hillard M Lazarus, Andrea A Bacigalupo, Karen K Ballen, Christopher N Bredeson, Matthew H Carabasi, Vikas Gupta, Gregory A Hale, Hanna Jean Khoury, Mark B Juckett, Mark R Litzow, Rodrigo Martino, Philip L McCarthy, Franklin O Smith, J Douglas Rizzo, Marcelo C Pasquini
Affiliations
Comparative Study

Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made?

John T Horan et al. J Clin Oncol. .

Abstract

Purpose: Transplantation-related mortality (TRM) is a major barrier to the success of allogeneic hematopoietic cell transplantation (HCT).

Patients and methods: We assessed changes in the incidence of TRM and overall survival from 1985 through 2004 in 5,972 patients younger than age 50 years who received myeloablative conditioning and HCT for acute myeloid leukemia (AML) in first complete remission (CR1) or second complete remission (CR2).

Results: Among HLA-matched sibling donor transplantation recipients, the relative risks (RRs) for TRM were 0.5 and 0.3 for 2000 to 2004 compared with those for 1985 to 1989 in patients in CR1 and CR2, respectively (P < .001). The RRs for all causes of mortality in the latter period were 0.73 (P = .001) and 0.60 (P = .005) for the CR1 and CR2 groups, respectively. Among unrelated donor transplantation recipients, the RRs for TRM were 0.73 (P = .095) and 0.58 (P < .001) for 2000 to 2004 compared with those in 1990 to 1994 in the CR1 and CR2 groups, respectively. Reductions in mortality were observed in the CR2 group (RR, 0.74; P = .03) but not in the CR1 group.

Conclusion: Our results suggest that innovations in transplantation care since the 1980s and 1990s have reduced the risk of TRM in patients undergoing allogeneic HCT for AML and that this reduction has been accompanied by improvements in overall survival.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Transplantation-related mortality by 5-year periods. (A) Recipients of HLA-matched related donors in first complete remission, (B) recipients of matched related donors in second complete remission, (C) recipients of unrelated donors in first complete remission, and (D) recipients of unrelated donors in second complete remission.
Fig 2.
Fig 2.
Transplantation-related mortality adjusted for patient and disease characteristics. (A) Recipients of HLA-matched related donor grafts and (B) recipients of unrelated donor grafts.
Fig 3.
Fig 3.
Transplantation-related mortality adjusted for patient and disease characteristics from 2000 to 2004 compared with that for 1985 to 1989 (baseline), among selected subgroups of HLA-identical sibling transplantation recipients with acute myeloid leukemia in first complete remission (CR1) and second complete remission (CR2). CSA, cyclosporine; MTX, methotrexate.
Fig 4.
Fig 4.
Adjusted overall survival by 5-year periods. (A) Recipients of HLA-matched related donors in first complete remission, (B) recipients of matched related donors in second complete remission, (C) recipients of unrelated donors in first complete remission, and (D) recipients of unrelated donors in second complete remission.
See this image and copyright information in PMC

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