Background
Methods
Data sources
Patients
Definitions and study endpoints
Statistical analysis
Results
Baseline characteristics
Variable | N = 249 (%) |
---|---|
Median age at HCT, years (range) | 56 (21–77) |
Male gender | 150 (60) |
Race | |
Caucasian | 214 (86) |
African American | 5 (2) |
Othersa | 17 (7) |
Missing | 13 (5) |
Karnofsky performance score ≥ 90 | 119 (48) |
< 90 | 113 (45) |
Missing | 17 (7) |
HCT-CI | |
0 | 46 (18) |
1–2 | 53 (21) |
≥ 3 | 84 (34) |
Not available before 2007 | 55 (22) |
Missing | 11 (4) |
Interval from diagnosis to HCT, months | |
Median (range) | 14 (3–118) |
Median lines of therapy before HCT (range) | 3 (1–5) |
Remission status at HCT | |
Complete remission | 108 (43) |
Partial remission | 90 (36) |
Chemorefractory | 38 (15) |
Untreated/unknown | 13 (5) |
History of prior autologous HCT | 98 (39) |
TBI in conditioning | 83 (34) |
ATG/alemtuzumab in conditioningb | 59 (24) |
Conditioning intensityc | |
Myeloablative conditioning | 66 (27) |
Non-myeloablative/RIC | 183 (73) |
Graft source | |
Bone marrow | 8 (3) |
Peripheral blood | 241 (97) |
Donor type | |
HLA-identical sibling | 140 (56) |
Unrelated donor 8/8 | 109 (44) |
Donor/recipient CMV status | |
Both negative | 72 (29) |
Both positive | 59 (24) |
Either donor/recipient + | 69 (28) |
Missing | 49 (19) |
Graft-versus-host disease prophylaxis | |
Calcineurin inhibitor + MTX ± othersd (except MMF) | 119 (48) |
Calcineurin inhibitor + MMF ± othersd | 76 (31) |
Calcineurin inhibitor + others (except MMF) | 40 (16) |
Othersd | 10 (4) |
Missing | 4 (2) |
Year of HCT | |
2000–2006 | 47 (19) |
2007–2011 | 82 (33) |
2012–2016 | 120 (48) |
Median follow-up of survivors (range), months | 49 (4–170) |
Hematopoietic recovery
Outcomes | N Eval | Prob (95% CI) |
---|---|---|
Neutrophil engraftment |
236
| |
1-year | 97 (94–99)% | |
2-year | 97 (94–99)% | |
Platelet recovery |
218
| |
1-year | 91 (87–94)% | |
2-year | 91 (87–95)% | |
Acute GVHD (II-IV) |
239
| |
180-day | 36 (30–42)% | |
Acute GVHD (III-IV) |
229
| |
180-day | 12 (8–17)% | |
Chronic GVHD |
230
| |
1-year | 49 (43–56)% | |
2-year | 58 (51–64)% | |
Extensive cGVHD |
230
| |
1-year | 39 (33–46)% | |
2-year | 46 (39–53)% | |
GRFS |
230
| |
1-year | 35 (29–41)% | |
2-year | 27 (21–33)% | |
NRM |
249
| |
1-year | 19 (14–24)% | |
2-year | 25 (20–31)% | |
4-year | 30 (24–36)% | |
Progression/relapse |
249
| |
1-year | 15 (11–20)% | |
2-year | 19 (15–25)% | |
4-year | 21 (16–27)% | |
PFS |
249
| |
1-year | 66 (60–72)% | |
2-year | 56 (49–62)% | |
4-year | 47 (41–54)% | |
Overall survival |
249
| |
1-year | 73 (68–79)% | |
2-year | 63 (56–69)% | |
4-year | 56 (49–63)% |
Acute and chronic GVHD
Number | RR | 95% CI lower limit | 95% CI upper limit | P-value | Overall p value | |
---|---|---|---|---|---|---|
Chronic GVHD | ||||||
ATG/alemtuzumab | ||||||
No | 174 | 1 |
0.02
| |||
Yes | 55 | 0.58 | 0.36 | 0.93 |
0.02
| |
Progression/Relapse | ||||||
No significant covariates | ||||||
Non-relapse mortality | ||||||
No significant covariates | ||||||
Progression-free survival | ||||||
Disease status | ||||||
CR | 108 | 1 |
0.03
| |||
PR | 90 | 1.13 | 0.76 | 1.66 | 0.54 | |
Chemoresistant | 38 | 1.73 | 1.08 | 2.77 |
0.02
| |
Missing/Untreated | 13 | 0.43 | 0.15 | 1.20 | 0.11 | |
Overall survival | ||||||
Karnofsky performance score (≤ 6 months)a | ||||||
≥ 90% | 119 | 1 |
0.002
| |||
< 90% | 113 | 3.46 | 1.74 | 6.87 |
0.0004
| |
Missing | 17 | 1.95 | 0.54 | 6.98 | 0.31 | |
Karnofsky performance score (> 6 months)a | ||||||
≥ 90% | 106 | 1 | 0.28 | |||
< 90% | 80 | 0.66 | 0.39 | 1.12 | 0.12 | |
Missing | 14 | 0.73 | 0.29 | 1.86 | 0.51 |
Transplantation outcomes
Causes of death
Impact of prior autograft and disease status
Outcomes | No prior auto-HCT (N = 151) | Prior auto-HCT (N = 98) | p value | ||
---|---|---|---|---|---|
N
| Prob (95% CI) |
N
| Prob (95% CI) | ||
NRM |
151
|
98
| 0.25 | ||
1-year | 17 (11–23)% | 22 (14–30)% | 0.33 | ||
2-year | 21 (15–28)% | 31 (22–41)% | 0.08 | ||
3-year | 22 (16–29)% | 33 (23–43)% | 0.07 | ||
4-year | 26 (19–34)% | 36 (26–47)% | 0.11 | ||
Progression/relapse |
151
|
98
| 0.69 | ||
1-year | 16 (11–22)% | 15 (8–22)% | 0.77 | ||
2-year | 22 (15–29)% | 16 (9–24)% | 0.23 | ||
3-year | 23 (16–30)% | 17 (10–25)% | 0.28 | ||
4-year | 24 (17–31)% | 17 (10–25)% | 0.21 | ||
PFS |
151
|
98
| 0.45 | ||
1-year | 68 (60–75)% | 64 (54–73)% | 0.56 | ||
2-year | 57 (49–65)% | 53 (43–63)% | 0.53 | ||
3-year | 55 (47–64)% | 50 (40–61)% | 0.43 | ||
4-year | 50 (42–59)% | 47 (36–57)% | 0.60 | ||
Overall survival |
151
|
98
| 0.81 | ||
1-year | 73 (65–80)% | 74 (65–82)% | 0.81 | ||
2-year | 65 (57–72)% | 59 (49–69)% | 0.43 | ||
3-year | 61 (53–69)% | 58 (47–68)% | 0.63 | ||
4-year | 57 (49–65)% | 54 (44–65)% | 0.70 |
CR1 (N = 33) | CR > 1 (N = 75) | PR (N = 90) | Refractory (N = 38) | |||||
---|---|---|---|---|---|---|---|---|
Outcomes |
N
| Prob (95% CI) |
N
| Prob (95% CI) |
N
| Prob (95% CI) |
N
| Prob (95% CI) |
NRM |
33
|
75
|
90
|
38
| ||||
1-year | 6 (1–17)% | 20 (12–30)% | 20 (13–29)% | 24 (12–38)% | ||||
2-year | 13 (4–26)% | 29 (19–40)% | 25 (17–35)% | 30 (16–45)% | ||||
3-year | 17 (6–32)% | 31 (21–43)% | 25 (17–35)% | 30 (16–45)% | ||||
4-year | 17 (6–32)% | 36 (25–49)% | 33 (22–44)% | 30 (16–45)% | ||||
Progression/ relapse |
33
|
75
|
90
|
38
| ||||
1-year | 15 (5–29)% | 13 (7–22)% | 14 (7–21)% | 29 (16–44)% | ||||
2-year | 25 (12–41)% | 16 (9–26)% | 19 (11–28)% | 29 (16–44)% | ||||
3-year | 25 (12–41)% | 18 (10–28)% | 19 (11–28)% | 32 (18–48)% | ||||
4-year | 25 (12–41)% | 18 (10–28)% | 21 (12–30)% | 32 (18–48)% | ||||
PFS |
33
|
75
|
90
|
38
| ||||
1-year | 79 (63–91)% | 67 (56–77)% | 66 (56–76)% | 47 (32–63)% | ||||
2-year | 62 (45–78)% | 54 (43–66)% | 56 (45–66)% | 41 (26–57)% | ||||
3-year | 58 (41–75)% | 50 (38–62)% | 56 (45–66)% | 38 (23–54)% | ||||
4-year | 58 (41–75)% | 45 (33–58)% | 47 (36–58)% | 38 (23–54)% | ||||
Overall survival |
33
|
75
|
90
|
38
| ||||
1-year | 88 (75–97)% | 73 (63–83)% | 71 (61–80)% | 63 (47–78)% | ||||
2-year | 78 (62–90)% | 62 (51–73)% | 59 (48–69)% | 52 (36–67)% | ||||
3-year | 70 (52–85)% | 58 (46–70)% | 57 (47–68)% | 52 (36–67)% | ||||
4-year | 70 (52–85)% | 54 (41–66)% | 50 (39–62)% | 52 (36–67)% |