Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia

Abstract

Although recent improvements have been indicated in the outcome after allogeneic hematopoietic cell transplantation (allo-HCT), little information is available on how changes in transplant modalities have affected the outcomes after allo-HCT in non-remission, based on patient age, donor source and disease type. We compared the incidence and causes of non-relapse mortality (NRM) after allo-HCT in non-remission among three consecutive four-year periods using a nationwide transplant outcome registry database. A total of 3308 patients with acute leukemia in non-remission were analyzed. The risk of NRM decreased over the three periods, and the hazard ratios We found that a decrease in the incidences of death due to GVHD and infection contributed to the reduction in NRM, to which high-resolution donor-recipient HLA matching and other improvements may have contributed. As none of the subgroups showed improved survival without a reduction in NRM, the effective prevention of transplant-related complications appears to be necessary for improving outcomes after allo-HCT in non-remission.

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

“…These results are compatible with prior reports. [1][2][3][4][5][6][7] There were remarkable changes in patient background characteristics over the three periods, such as an increased number of cases of HSCT from a UBM donor, older patients and patients with high-risk disease. Despite the extended application of HSCT to these more vulnerable patients, there was an improvement in outcome after HSCT.…”

“…Recently, several studies have shown improvements in outcomes of allo-HSCT over the past few decades, [1][2][3][4][5][6][7] explained mainly by the decreased risk of NRM.…”

“…1 An analysis from the European Group for Blood and Marrow Transplantation focused on causes of mortality after allo-HSCT from an HLA-identical sibling donor, and showed that death from infections was significantly reduced. 4 Kurosawa et al 3,7 analyzed the Japan transplant outcome registry database, and demonstrated that reductions in the incidences of death due to GVHD, infection and organ failure led to a decrease in NRM after allo-HSCT. It may be more important to distinguish between infection after augmentation of immunosuppressive therapy for GVHD and infection without such intervention to further delineate ways of improving HSCT outcomes.…”

Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia

“…Improvements in these treatment modalities [1][2][3][4][5][6][7][8] have resulted in a growing number of acute leukemia survivors. Allo-HCT is a potentially curative treatment strategy that reduces the risk of relapse, however, it carries an attendant risk of significant acute complications and late effects that may lead to non-relapse mortality.…”

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

“…However, HCT continues to be associated with substantial rates of non-relapse mortality (NRM) (3-year NRM of 20-30%). 22,23 Our team has previously shown that malglycemia (hyperglycemia, hypoglycemia or increased glycemic variability) was associated with increased day-200 NRM, overall mortality and infection rate. Our earlier study demonstrated that glucose values above 200 mg/dL were associated with twofold or more increase in NRM, compared with BG values between 101 and 150 mg/dL.…”