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Graft Manipulation

Long-term prognosis for 1-year relapse-free survivors of CD34+ cell-selected allogeneic hematopoietic stem cell transplantation: a landmark analysis

Bone Marrow Transplantation volume 52, pages 1629–1636 (2017)Cite this article

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Abstract

CD34+ cell selection significantly improves GvHD-free survival in allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, specific information regarding long-term prognosis and risk factors for late mortality after CD34+ cell-selected allo-HSCT is lacking. We conducted a single-center landmark analysis in 276 patients alive without relapse 1 year after CD34+ cell-selected allo-HSCT for AML (n=164), ALL (n=33) or myelodysplastic syndrome (n=79). At 5 years’ follow-up after the 1-year landmark (range 0.03–13 years), estimated relapse-free survival (RFS) was 73% and overall survival (OS) 76%. The 5-year cumulative incidence of relapse and non-relapse mortality (NRM) were 11% and 16%, respectively. In multivariate analysis, Hematopoietic Cell Transplantation Comorbidity Index score⩾3 correlated with marginally worse RFS (hazard ratio (HR) 1.78, 95% confidence interval (CI) 0.97–3.28, P=0.06) and significantly worse OS (HR 2.53, 95% CI 1.26–5.08, P=0.004). Despite only 24% of patients with acute GvHD within 1 year, this also significantly correlated with worse RFS and OS, with increasing grades of acute GvHD associating with increasingly poorer survival on multivariate analysis (P<0.0001). Of 63 deaths after the landmark, GvHD accounted for 27% of deaths and was the most common cause of late mortality, followed by relapse and infection. Although prognosis is excellent for patients alive without relapse 1 year after CD34+ cell-selected allo-HSCT, risks of late relapse and NRM persist, particularly due to GvHD.

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Acknowledgements

This research was supported in part by National Institutes of Health award number P01 CA23766 and NIH/NCI Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    C Cho, M A Maloy, J N Barker, H Castro-Malaspina, S A Giralt, A A Jakubowski, G Koehne, E B Papadopoulos, D M Ponce, R Tamari, M R M van den Brink, J W Young & M-A Perales

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    C Cho, J N Barker, H Castro-Malaspina, S A Giralt, A A Jakubowski, G Koehne, E B Papadopoulos, D M Ponce, R Tamari, M R M van den Brink, J W Young & M-A Perales

  3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    M Hsu & S M Devlin

  4. Department of Hematology, Hospital Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain

    P Barba

  5. Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    S T Avecilla & R C Meagher

  6. Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    R J O’Reilly

  7. The Rockefeller University, New York, 10065, NY, USA

    J W Young

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  1. C Cho
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  2. M Hsu
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  9. A A Jakubowski
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  10. G Koehne
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  11. R C Meagher
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  13. E B Papadopoulos
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  14. D M Ponce
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  15. R Tamari
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  16. M R M van den Brink
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  17. J W Young
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  18. S M Devlin
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  19. M-A Perales
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Correspondence to C Cho or M-A Perales.

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Cho, C., Hsu, M., Barba, P. et al. Long-term prognosis for 1-year relapse-free survivors of CD34+ cell-selected allogeneic hematopoietic stem cell transplantation: a landmark analysis. Bone Marrow Transplant 52, 1629–1636 (2017). https://doi.org/10.1038/bmt.2017.197

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