Development and validation of a comorbidity index for predicting survival outcomes after allogeneic stem cell transplantation in adult patients with acute leukemia: a Korean nationwide cohort study

Kim, Hee-Je; Yoon, Jae‐Ho; Lee, Joon Yeop; Lee, Jong Hyuk; Min, Gi June; Park, Silvia; Yoon, Jihyun; Lee, Sung‐Eun; Cho, Byung-Sik; Eom, Ki‐Seong; Kim, Yoo-Jin; Lee, Seok; Kim, Dong-Wook

doi:10.5045/br.2021.2021107

Cited by 5 publications

(3 citation statements)

References 22 publications

(19 reference statements)

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“…It carries a comprehensive set of databases comprising the health information of 50 million Koreans, including demographic variables such as age and sex, and medical treatment databases harboring universal medical claims and mortality data involving the whole Korean population 15 . Accordingly, KNHIS database has contributed to various epidemiological investigations into hematologic disease 16‐20 …”

Section: Methodsmentioning

confidence: 99%

“…15 Accordingly, KNHIS database has contributed to various epidemiological investigations into hematologic disease. [16][17][18][19][20] The study protocol is described in Figure 1. For patients in the primitive case and case cohorts, the index date was defined as the date of allo-SCT, whereas the index date was indicated as the year of participation in the public health checkup for individuals in the primitive control and control cohorts.…”

Section: Data Sourcementioning

confidence: 99%

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Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study

Park

Han

2022

Intl Journal of Cancer

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Our study investigated the incidence of secondary nonhematologic malignancies in patients undergoing allogeneic hematopoietic stem cell transplantation (allo‐SCT) and explored its risk compared to the general population. A population‐based case cohorts with adult patients who received allo‐SCT between January 2002 and December 2018 and a control cohort with matched general population were extracted from the Korean National Health Insurance Service database. Each case and control cohort included 5177 patients. With a median follow‐up of 2374 days for the case cohort and 2269 days for the control cohort, the 10‐year cumulative incidence rate of nonhematologic malignancy was significantly higher in the case cohort compared to the control cohort (4.23% vs 2.3%, hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.32‐2.25, P < .001). The sub‐class analysis according to cancer‐site revealed significantly higher risks of 10‐year cumulative incidence for cancers of head, neck and esophagus (HR 3.19, 95% CI 1.34‐7.59, P = .003); cancers involving upper gastrointestinal tract (HR 3.74, 95% CI 1.58‐8.85, P < .001), colorectal cancer (HR 2.02, 95% CI 1.04‐3.91, P = .029), thyroid cancer (HR 2.09, 95% CI 1.1‐3.97, P = .012), gynecological cancer (HR 2.69, 95% CI 1.04‐6.96, P = .048) in the case cohort compared to the control cohort. No significant differences were detected for cancers involving lung, mediastinum and heart, breast cancer in female, cancers of the hepatobiliary and pancreatic system and cancers associated with urological system. These findings suggest the need for enhanced screening for nonhematologic malignancies in allo‐SCT recipients compared to the general population.

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Section: Methodsmentioning

confidence: 99%

Section: Data Sourcementioning

confidence: 99%

Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study

Park

Han

2022

Intl Journal of Cancer

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“…Because the AML is primarily a disease of the elderly with a median age at diagnosis over 60 years 4,5 , the use of reduced intensity conditioning (RIC) regimens has broadened the applicability of allogeneic HSCT to older adults with AML 6,7 . Historically, RIC was recognized as an 'unavoidable' alternative to myeloablative conditioning (MAC) for administering HSCT to fragile patients with an increasing concern of higher risk of relapse at the cost of lower treatment-related mortality 6,8,9 . Recently, however, similar outcomes between MAC and RIC in terms of post-HSCT survival and relapse in patients with AML were reported in a series of prospective studies [10][11][12] and RIC was suggested a reasonable option even in a subset of young and healthy patients.…”

Section: Introductionmentioning

confidence: 99%

Reduced toxicity (FluBu3) versus myeloablative (BuCy) conditioning in acute myeloid leukemia patients who received first allogeneic hematopoietic stem cell transplantation in measurable residual disease-negative CR1

Park,

Bang,

Kwag

et al. 2024

Bone Marrow Transplant

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In the present study, reduced toxicity (FluBu3) and myeloablative (BuCy) conditioning were compared in patients with AML who received rst allogeneic HSCT in MRD-negative CR1. The study included 124 adult patients who underwent HSCT from an HLA-matched (8/8) sibling, unrelated, or 1-locus mismatched (7/8) unrelated donor (MMUD). The median age was 45 years and intermediate cytogenetics comprised majority (71.8%). The 2-year OS, RFS, CIR and NRM for BuCy (n = 78, 62.9%) and FluBu3 (n = 46, 37.1%) groups were 78.3% and 84.5% (p = 0.358), 78.0% and 76.3% (p = 0.806), 7.7% and 21.5% (p = 0.074) and 14.3% and 2.2% (p = 0.0324), respectively. At the time of data cut-off, relapse and NRM were the main causes of HSCT failure in each of the FluBu3 and BuCy arms. Among patients, 75% of relapsed FluBu3 patients had high-risk features of either poor cytogenetics or FLT3-ITD mutation compared with 16.7% of BuCy patients. The majority of NRM in the BuCy group was due to GVHD (73%), half of whom received MMUD transplantation. To conclude, the FluBu3 reduced toxicity conditioning showed comparable post-transplant OS and RFS to BuCy and was associated with signi cantly reduced NRM that was offset by a trend towards higher risk of relapse even in MRD-negative CR1 population.

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Metabolic Disease Incidence After Allogeneic Stem Cell Transplantation: A Nationwide Korean Case-Control Study

Park

Han

2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context and Objectives There have been no large-scale reports elucidating the relative risks of developing metabolic diseases in adult allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients compared to the general population. Participants and Methods We conducted a population-based case-control study and analyzed data of 8,230 adult allo-HSCT recipients and 32,920 healthy individuals matched for age, sex, and the index date in a 1:4 ratio, using a nationwide database of the Korean National Health Insurance Service. Thereafter, we established four sub-studies to investigate the relative risks of metabolic disease development following allo-HSCT: hypertension (cohort A study), diabetes (cohort B study), dyslipidemia (cohort C study), and CVA (cohort D study). Results The 10-year cumulative incidence of metabolic disease in each experimental cohort was significantly higher than that in the control cohort (overall p-value <0.001 for all): cohort A study, 17.6% vs. 11.8%; cohort B study, 23.5% vs. 14.4%; cohort C study for dyslipidemia, 44.5% vs. 32.1%; and cohort D study for CVA, 4.2% vs. 3.2%. In comparison to the incidence of metabolic diseases in the general population, allo-HSCT recipients presented adjusted hazard ratios of 1.58 for hypertension, 2.06 for diabetes, 1.62 for dyslipidemia, and 1.45 for CVA. Conclusions Recipients of allo-HSCT need to be rigorously monitored for the development of metabolic diseases, including hypertension, diabetes, dyslipidemia, and CVA, based on an enhanced lifelong healthcare policy including a robust screening program compared to the general population.

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Development and validation of a comorbidity index for predicting survival outcomes after allogeneic stem cell transplantation in adult patients with acute leukemia: a Korean nationwide cohort study

Abstract: Development and validation of a comorbidity index for predicting survival outcomes after allogeneic stem cell transplantation in adult patients with acute leukemia: a Korean nationwide cohort study. Blood Res 2021.

Cited by 5 publications

References 22 publications

Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study

Risk of secondary nonhematologic malignancies after allogeneic stem cell transplantation: A nationwide case‐control cohort study

Reduced toxicity (FluBu3) versus myeloablative (BuCy) conditioning in acute myeloid leukemia patients who received first allogeneic hematopoietic stem cell transplantation in measurable residual disease-negative CR1

Metabolic Disease Incidence After Allogeneic Stem Cell Transplantation: A Nationwide Korean Case-Control Study

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