Journal
CANCER
Volume 115, Issue 20, Pages 4715-4726Publisher
WILEY
DOI: 10.1002/cncr.24531
Keywords
hematopoietic stem cell transplantation; outcome; risk score; allogeneic; hematological malignancy; leukemia
Categories
Funding
- European Leukemia Net [LSH-2002-2.2.0-3]
- Swiss National Research Foundation [3200B0-118176]
- Swiss Cancer League
- Regional Cancer League
- Horton Foundation
- Amgen Europe
- F. Hoffmann-La Roche Ltd
- Gilead Sciences UK
- Miltenyl Biotec GmbH
- Schering-Plough International Inc.
- Celegene International SARL
- Genzyme
- ViroPharma Europe
- Chugai Sanofi-Aventis
- Fresenius Biotech GmbH
- Gambro BCT
- Bayer Schering Pharma AG
- Therakos
- Bristol Myers Squibb
- Cephalon
- Pierre Fabre Medicament
- Alexion Europe
- Pfizer
- Biosafe SA
- Merck Sharp Dohme
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BACKGROUND: It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general. METHODS: Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5-77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005. RESULTS: Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%-73%) for risk score 0 for the whole cohort (75%, 95% Cl, 72%-78% for the most recent time cohort) to 24% (95% Cl, 21%-27% for risk score 6 and 7; 25%, 95% Cl, 22%-29% most recent cohort). Transplant-related mortality increased from 15% (95% Cl, 14%-17%) for risk score O (11%, 95% Cl, 9%-13%, most recent cohort) to 47% with risk score 6 and 7 (95% Cl, 44%-50%) for the whole cohort (45%, 95% Cl, 42%-48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques. CONCLUSIONS: Five well-defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies. Cancer 2009;115:4715-26. (C) 2009 American Cancer Society.
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