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. 2014 Jul 1;8(3):1-11.

The EBMT Risk Score in the Presence of Graft Versus Host Disease in Allogeneic Stem Cell Transplantation in Adult Acute Myelogenous Leukemia: A Multistate Model for Competing Risks

Arash Jalali  1 , Kamran Alimoghaddam  2 , Mahmood Mahmoudi  3 , Kazem Mohammad  3 , Hojjat Zeraati  3 , Seied Asadollah Mousavi  2 , Babak Bahar  2 , Mohammad Vaezi  2 , Mohammad Jahani  2 , Ardeshir Ghavamzadeh  2
Affiliations

The EBMT Risk Score in the Presence of Graft Versus Host Disease in Allogeneic Stem Cell Transplantation in Adult Acute Myelogenous Leukemia: A Multistate Model for Competing Risks

Arash Jalali et al. Int J Hematol Oncol Stem Cell Res. .

Abstract

The aim of this study was to assess the predictive effect of the EBMT risk score on the outcomes of allogeneic stem cell transplantation in a relatively homogenous group of acute myelogenous leukemia (AML) patients regarding the occurrence of acute and chronic graft versus host disease (GVHD). This historical cohort study included adult patients (≥ 15 years old) with AML (n=363) who received allogeneic peripheral blood stem cell transplantation from HLA-identical sibling donors in the first or higher complete remission following myeloablative conditioning regimens between 2004 and 2011.The patients recruited in this study were followed-up until January 2013. Patients with acute promyelocytic leukemia (APL) were excluded from the study. Early outcomes until day +100 and events after day +100 were regarded for acute and chronic GVHD, respectively. A multi state model for competing risks was applied. We found that the EBMT risk score was a good predictor for overall survival (OS) and relapse incidence; however, it was not associated with transplant-related mortality (TRM). The EBMT risk score was not associated with acute and chronic GVHD. For early outcomes, the predictive effect of the EBMT risk score was not statistically significant in the presence of acute GVHD; however, in the presence of chronic GVHD, it was a significant predictor of relapse but not for TRM. It seems that the effect of EBMT risk score on OS and relapse incidence cannot be affected by GVHD. Although the results were insignificant, there was evidence that the EBMT risk score can predict early outcomes, while for late outcomes, it works well for relapse and OS but not for TRM.

Keywords: Acute myeloid leukemia; Competing risks; Graft versus host disease; Multistate model; Peripheral blood stem cell transplantation; Survival analysis.

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Conflict of interest statement

CONFLICT OF INTEREST

All authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Multistate model for competing risks with four final states to take into account the information about the occurrence of GVHD
Figure 2
Figure 2
(a) OS, LFS, Relapse incidence, and TRM curves for all study patients; (b) OS, (c) cumulative incidence of relapse, and (d) cumulative incidence of TRM for different EBMT risk scores
Figure 3
Figure 3
Cumulative incidence of early relapse (a, b) and TRM (c, d) considering the occurrence of aGVHD in the first 100 days after transplant in different EBMT risk scores using a multistate approach for competing risks
Figure 4
Figure 4
Cumulative incidence of relapse (a, b) and TRM (c, d) considering the occurrence of cGVHD for patients at risk on the day 100 post-transplant in different EBMT risk scores using a multistate approach for competing risks
See this image and copyright information in PMC

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