Reduced mortality after allogeneic hematopoietic-cell transplantation
Ted A Gooley1, Jason W Chien, Steven A Pergam
1Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
The New England Journal of Medicine
|November 26, 2010
Summary
Advances in transplantation care have led to significantly improved patient outcomes. This study shows reduced mortality, lower relapse rates, and fewer complications in recent years compared to a decade prior.
Area of Science:
- Hematopoietic-cell transplantation research
- Transplantation medicine outcomes
Background:
- Recent advancements in patient care for transplantation.
- Need to evaluate the impact of these advancements on transplantation outcomes.
Purpose of the Study:
- To determine if recent advances in transplantation care have improved patient outcomes.
- To analyze changes in mortality, relapse rates, and complications over a decade.
Main Methods:
- Comparative analysis of 1418 patients (1993-1997) and 1148 patients (2003-2007) undergoing allogeneic transplantation.
- Evaluation of overall mortality, non-relapse mortality, malignancy recurrence, and major complications.
- Utilized Pretransplant Assessment of Mortality (PAM) score components for statistical adjustment.
Main Results:
- Significant reductions observed in non-relapse mortality (day 200 and overall), malignancy progression, and overall mortality in the 2003-2007 period compared to 1993-1997.
- Decreases in severe graft-versus-host disease (GVHD), infectious complications (viral, bacterial, fungal), and organ damage (hepatic, renal, pulmonary).
- Similar improvements noted in patients receiving myeloablative conditioning therapy.
Conclusions:
- Substantial reduction in the hazard of death following allogeneic hematopoietic-cell transplantation.
- Improved long-term survival attributed to decreased organ damage, infection, and acute GVHD.
- Evidence of significant progress in transplantation medicine over the past decade.
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