Analysis of non-relapse mortality and causes of death over 15 years following allogeneic hematopoietic stem cell transplantation

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has curative potential against hematological malignancies. However, there are concerns about the associated risk of non-relapse mortality (NRM). We performed a retrospective single-center study to assess changes in outcomes after allo-HSCT and causes of NRM over three 5-year periods. The rates of 2-year NRM and overall survival (OS) were 16% and 59%, respectively. We found a significant decrease in NRM (P o 0.001), with 2-year NRM of 26, 14 and 9%, and a significant increase in OS (P = 0.005), with 2-year OS of 52%, 58% and 65%, over the three periods (1998-2002, 2003-2007 and 2008-2012), respectively. Of note, a steady improvement was observed in NRM, period by period, among patients aged 50 years or older, patients who underwent HSCT from an unrelated bone marrow donor and patients who underwent HSCT with a reduced-intensity conditioning regimen. Our data showed that the improved NRM can mainly be attributed to a decreased mortality related to infection after starting systemic steroid as GVHD treatment, and a decreased mortality related to organ failure.

Effect of Itraconazole or Rifampin on Itacitinib Pharmacokinetics When Administered Orally in Healthy Subjects

“…In a separate study the nonrelapse mortality rate was 24% with 20.2% being attributed to GVHD . Nonrelapse mortality can also be due to infectious disease with an incidence between 0.3% and 3.3% for fungal infections . A similar mortality rate due to IFI was reported by Kontoyiannis et al of 3.4% overall following HSCT (both autologous and allogenic) but was higher in allogenic HSCT ranging between 5.8% and 8.1% in matched‐related donors and mismatched‐related donors with a 1‐year survival of 25.4% in patients with aspergillosis infections …”

“…Two major complications of HSCT are graft‐versus‐host disease (GVHD) and invasive fungal infections (IFI), both leading to major morbidity and mortality. Following allogenic HSCT, grade II‐IV acute GVHD and chronic GVHD occur in 38% to 46% and 37% to 43% of patients, respectively, with mortality rates ranging between 0.3% and 1.7% in acute and 0.8% and 2.5% in chronic cases . In a separate study the nonrelapse mortality rate was 24% with 20.2% being attributed to GVHD .…”

Ruxolitinib for the Treatment of Patients with Steroid-Refractory GVHD: An Introduction to the REACH Trials

“…Although a recent trend analysis suggested that incidences of aGVHD and cGVHD following allogeneic HSCT have decreased in recent years [49], GVHD continues to pose a significant burden to transplant success and represents a leading cause of NRM [8,18,19]. The three REACH trials comprise the largest and most comprehensive prospective clinical trials to date evaluating a JAK1/JAK2 inhibitor in GVHD settings.…”

CAR-T Cells and Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia

“…The additional cost for CAR-T therapy is also high, which may prevent its more widespread use in the near future. Allo-HSCT is good option for some patients because the morbidity and mortality from allo-HSCT is not insignificant, however, we must pay attention to the potential GVHD complications [44].…”