title: Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made?
abstract: OBJECTIVE
  Transplantation-related mortality (TRM) is a major barrier to the success of allogeneic hematopoietic cell transplantation (HCT).
  
  
  METHODS
  We assessed changes in the incidence of TRM and overall survival from 1985 through 2004 in 5,972 patients younger than age 50 years who received myeloablative conditioning and HCT for acute myeloid leukemia (AML) in first complete remission (CR1) or second complete remission (CR2).
  
  
  RESULTS
  Among HLA-matched sibling donor transplantation recipients, the relative risks (RRs) for TRM were 0.5 and 0.3 for 2000 to 2004 compared with those for 1985 to 1989 in patients in CR1 and CR2, respectively (P < .001). The RRs for all causes of mortality in the latter period were 0.73 (P = .001) and 0.60 (P = .005) for the CR1 and CR2 groups, respectively. Among unrelated donor transplantation recipients, the RRs for TRM were 0.73 (P = .095) and 0.58 (P < .001) for 2000 to 2004 compared with those in 1990 to 1994 in the CR1 and CR2 groups, respectively. Reductions in mortality were observed in the CR2 group (RR, 0.74; P = .03) but not in the CR1 group.
  
  
  CONCLUSIONS
  Our results suggest that innovations in transplantation care since the 1980s and 1990s have reduced the risk of TRM in patients undergoing allogeneic HCT for AML and that this reduction has been accompanied by improvements in overall survival.
authors.affiliation: Children’s Healthcare of Atlanta at Egleston, Emory University Hospital, Atlanta, GA, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Horan
authors.forename: Brent R
authors.initials: BR
authors.lastname: Logan
authors.forename: Manza-A
authors.initials: MA
authors.lastname: Agovi-Johnson
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Bacigalupo
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Carabasi
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Hanna Jean
authors.initials: HJ
authors.lastname: Khoury
authors.forename: Mark B
authors.initials: MB
authors.lastname: Juckett
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.forename: Franklin O
authors.initials: FO
authors.lastname: Smith
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Pasquini
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods / Q000401:mortality*; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult