The primary cause of death (COD) provides important information in many studies of hematopoietic stem cell transplantation (HSCT). A panel of experts critically assessed the CODs submitted by 15 transplantation centers for 281 patients who died in a randomized multicenter trial of unrelated HSCT. The panel reviewed the CODs reported by the transplantation centers, which used the Center for International Blood and Marrow Transplant Research and National Marrow Donor Program COD reporting form. The panel determined that the existing criteria for primary and contributing CODs lacked sufficient stringency for uniform interpretation. A hierarchy was developed and applied to the T cell depletion project. Using its scheme, the panel reclassified 157 CODs (56%) reported by the transplantation centers. The changes resulted in increased recognition of graft-versus-host disease as the primary COD and a concomitant decrease in attribution of the primary COD to infection. This algorithm promotes consistent assignment of primary and contributing CODs for patients with leukemia or lymphoma who expire after myeloablative allogeneic HSCT.
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We thank the patients who willingly entered this large clinical trial; the physicians, nurses, and other support staff who cared for them during the transplant procedure; and the clinical investigation team at each participating institution for data collection and follow-up. We also thank the National Heart, Lung, and Blood Institute (NHLBI) for support of this trial. In addition to the authors, the following transplantation centers, study physicians, and experts contributed to this study: University of Minnesota (n = 103; Daniel J. Weisdorf, MD), Memorial Sloan-Kettering Cancer Center (n = 70; Richard O'Reilly, MD and Esperanza Papadoupolos, MD), Medical College of Virginia (n = 53), Wake Forest University-Baptist (n = 36), University of Nebraska (n = 34; Stephen Pavletic, MD and Michael Bishop, MD), University of Utah (n = 33; Patrick Beatty, MD and Finn Bo Petersen, MD), Stanford University (n = 25; Robert Negrin, MD), University of Iowa (n = 19; Robert Gingrich, MD), University of South Carolina (n = 13; Jean Henslee-Downey, MD and Kamar Godder, MD), Ohio State University (n = 6), Duke University (n = 6; Joanne Kurtzberg, MD), University of Kentucky (n = 5; John S. Thompson, MD and Gordon Phillips, MD), Medical College of Wisconsin (n = 4; Neal Flomenberg, MD), Western Pennsylvania Hospital (n = 2; Richard Shattuck, MD), University of Pittsburgh (n = 1; Albert Donnenberg, PhD), the EMMES Corporation (Donald Stablein, PhD and Elizabeth Wagner, M.P.H.), and the National Heart, Lung, and Blood Institute (LeeAnn Jensen, PhD, Nancy Geller, PhD, and Paul McCurdy, MD).
- Cause of death
- Hematopoietic stem cell transplantation
- T cell depletion