TY - JOUR
T1 - Composite end point of graft-versus-host disease-free, relapse-free survival after allogeneic hematopoietic cell transplantation
AU - Holtan, Shernan G.
AU - DeFor, Todd E.
AU - Lazaryan, Aleksandr
AU - Bejanyan, Nelli
AU - Arora, Mukta
AU - Brunstein, Claudio G.
AU - Blazar, Bruce R.
AU - MacMillan, Margaret L.
AU - Weisdorf, Daniel J.
N1 - Publisher Copyright:
© 2015 by The American Society of Hematology.
PY - 2015/2/19
Y1 - 2015/2/19
N2 - 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.
AB - 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.
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U2 - 10.1182/blood-2014-10-609032
DO - 10.1182/blood-2014-10-609032
M3 - Article
C2 - 25593335
AN - SCOPUS:84923348954
SN - 0006-4971
VL - 125
SP - 1333
EP - 1338
JO - Blood
JF - Blood
IS - 8
ER -