Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8430819 | Biology of Blood and Marrow Transplantation | 2011 | 36 Pages |
Abstract
Factors that impact first-year morbidity and mortality in adults undergoing myeloablative allogeneic hematopoietic cell transplantation with ex vivo CD34+ selection have not been previously reported. We assessed all toxicities ⥠grade 3 from the start of conditioning to date of death, relapse, or last contact in 200 patients during the first year after transplantation, identifying 1885 individual toxicities among 17 organ-based toxicity groups. The most prevalent toxicities in the first year were of infectious, metabolic, hematologic, oral/gastrointestinal, hepatic, cardiac, and pulmonary etiologies. Renal complications were minimal. Grades II to IV and III and IV acute GVHD at day 100 were 11.5% and 3%, respectively. In separate multivariate models, cardiovascular, hematologic, hepatic, neurologic, pulmonary, and renal toxicities negatively impacted nonrelapse mortality (NRM) and overall survival during the first year. A higher-than-targeted busulfan level, patient cytomegalovirus seropositivity, and an Hematopoietic Cell Transplantation-Specific Comorbidity Index of â¥3 were associated with increased risk of NRM and all-cause death. Ex vivo CD34+ selection had a favorable 1-year OS of 75% and NRM of 17% and a low incidence of sinusoidal obstruction syndrome. These data establish a benchmark to focus efforts in reducing toxicity burden while improving patient outcomes.
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Authors
Satyajit Kosuri, Diego Adrianzen Herrera, Michael Scordo, Gunjan L. Shah, Christina Cho, Sean M. Devlin, Molly A. Maloy, Jimmy Nieves, Taylor Borrill, Dean C. Carlow, Scott T. Avecilla, Richard C. Meagher, Richard J. O'Reilly, Esperanza B. Papadopoulos,