Composite end point of graft-versus-host disease-free, relapse-free survival after allogeneic hematopoietic cell transplantation

Shernan G. Holtan, Todd E. DeFor, Aleksandr Lazaryan, Nelli Bejanyan, Mukta Arora, Claudio G. Brunstein, Bruce R. Blazar, Margaret L. MacMillan, Daniel J. Weisdorf

Research output: Contribution to journalArticlepeer-review

400 Scopus citations

Abstract

The success of allogeneic hematopoietic cell transplantation (HCT) is typically assessed as individual complications, including graft-versus-host disease (GVHD), relapse, or death, yet no one factor can completely characterize cure without ongoing morbidity. We examined a novel composite end point of GVHD-free/relapse-free survival (GRFS) in which events include grade 3-4 acute GVHD, systemic therapy-requiring chronicGVHD, relapse, or death in the first post-HCT year. In 907 consecutive University of Minnesota allogeneic HCT recipients (2000-2012), 1-year GRFS was 31% (95% confidence interval [CI] 28-34). Regression analyses showed age, disease risk, and donor type significantly influencing GRFS. Adults age 21+ had 2-fold worseGRFSvs children;GRFSdid not differ beyondage 21. Adjusted for conditioning intensity, stem cell source, disease risk, age, and transplant year, HLA-matched sibling donor marrow resulted in the best GRFS (51%, 95% CI 46-66), whereas HLA-matched sibling donor peripheral blood stem cells were significantly worse (25%, 95% CI 20-30, P = .01). GRFS after umbilical cord blood transplants and marrowfrommatched unrelated donors were similar (31%, 95% CI 27-35 and 32%, 95% CI 22-42, respectively). BecauseGRFSmeasures freedom fromongoingmorbidity and represents ideal HCT recovery, GRFS has value as a novel end point for benchmarking new therapies. (Blood.

Original languageEnglish (US)
Pages (from-to)1333-1338
Number of pages6
JournalBlood
Volume125
Issue number8
DOIs
StatePublished - Feb 19 2015

Bibliographical note

Publisher Copyright:
© 2015 by The American Society of Hematology.

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