Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Bone Marrow Transplant. 2021 Aug;56(8):2005-2012. doi: 10.1038/s41409-021-01274-1. Epub 2021 Apr 12.
Despite low nonrelapse mortality (NRM) at day 100 after allogeneic hematopoietic cell transplantation (HCT), NRM at 1 year remains substantial. In this study, we retrospectively analyzed 199 patients who were treated on a phase II clinical trial assessing safety and efficacy of myeloablative fractionated busulfan and fludarabine conditioning regimen for hematologic malignancies. The goal of the study was to identify factors associated with NRM occurring between days 101 and 365 post-HCT and generate a hypothesis for future studies to reduce the risk of NRM at 1 year. We found that a vast majority (83%) of patients who experienced NRM between days 101 and 365 had prior grade II-IV acute graft-versus-host disease (GVHD), which was the leading cause of death either by itself (33.3%) or complicated by infections (37.5%). In multivariate analysis, grade II-IV acute GVHD (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.3-6.6, p = 0.01) was the only significant predictor of NRM between days 101 and 365. Measures to reduce the risk of acute GVHD could lower the risk of NRM at 1 year and improve overall survival.
尽管异基因造血细胞移植（HCT）后 100 天的非复发死亡率（NRM）较低，但 1 年的 NRM 仍然很高。在这项研究中，我们回顾性分析了 199 名接受 II 期临床试验评估血液恶性肿瘤患者接受清髓性分次白消安和氟达拉滨预处理方案的安全性和有效性的患者。该研究的目的是确定与 HCT 后 101 至 365 天之间发生的 NRM 相关的因素，并为未来降低 1 年 NRM 风险的研究提出假设。我们发现，绝大多数（83%）在 101 至 365 天之间发生 NRM 的患者在之前患有 II 至 IV 级急性移植物抗宿主病（GVHD），GVHD 是导致死亡的主要原因，无论是单独（33.3%）还是合并感染（37.5%）。多变量分析显示，II 至 IV 级急性 GVHD（危险比（HR）2.9，95%置信区间（CI）1.3-6.6，p=0.01）是 101 至 365 天之间 NRM 的唯一显著预测因素。降低急性 GVHD 风险的措施可以降低 1 年的 NRM 风险并改善总体生存。
