Jalali Arash, Alimoghaddam Kamran, Mahmoudi Mahmood, Mohammad Kazem, Zeraati Hojjat, Mousavi Seied Asadollah, Bahar Babak, Vaezi Mohammad, Jahani Mohammad, Ghavamzadeh Ardeshir
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran ; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Int J Hematol Oncol Stem Cell Res. 2014 Jul 1;8(3):1-11.
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.
本研究的目的是评估EBMT风险评分对一组相对同质的急性髓系白血病（AML）患者进行异基因干细胞移植后急性和慢性移植物抗宿主病（GVHD）发生情况的预测效果。这项历史性队列研究纳入了2004年至2011年间接受清髓性预处理方案后处于首次或更高完全缓解期、从HLA匹配的同胞供体接受异基因外周血干细胞移植的成年AML患者（≥15岁，n = 363）。本研究招募的患者随访至2013年1月。急性早幼粒细胞白血病（APL）患者被排除在研究之外。分别将至+100天的早期结局和+100天后的事件视为急性和慢性GVHD。应用了竞争风险的多状态模型。我们发现EBMT风险评分是总生存期（OS）和复发率的良好预测指标；然而，它与移植相关死亡率（TRM）无关。EBMT风险评分与急性和慢性GVHD均无关。对于早期结局，在存在急性GVHD的情况下，EBMT风险评分的预测效果无统计学意义；然而，在存在慢性GVHD的情况下，它是复发的显著预测指标，但不是TRM的预测指标。似乎EBMT风险评分对OS和复发率的影响不受GVHD的影响。尽管结果不显著，但有证据表明EBMT风险评分可以预测早期结局，而对于晚期结局，它对复发和OS有效，但对TRM无效。
