title: Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia.
abstract: Although recent improvements have been indicated in the outcome after allogeneic hematopoietic cell transplantation (allo-HCT), little information is available on how changes in transplant modalities have affected the outcomes after allo-HCT in non-remission, based on patient age, donor source and disease type. We compared the incidence and causes of non-relapse mortality (NRM) after allo-HCT in non-remission among three consecutive four-year periods using a nationwide transplant outcome registry database. A total of 3308 patients with acute leukemia in non-remission were analyzed. The risk of NRM decreased over the three periods, and the hazard ratios (HRs) in 2001-2004 and 2005-2008 compared with 1997-2000 were 0.86 (95% CI, 0.70-1.06; P=0.16) and 0.65 (95% CI, 0.53-0.80; P<0.01), respectively. A significant decrease in the HR for overall mortality was also observed in 2005-2008 (HR 0.85; 95% CI, 0.75-0.97; P=0.02). We found that a decrease in the incidences of death due to GVHD and infection contributed to the reduction in NRM, to which high-resolution donor-recipient HLA matching and other improvements may have contributed. As none of the subgroups showed improved survival without a reduction in NRM, the effective prevention of transplant-related complications appears to be necessary for improving outcomes after allo-HCT in non-remission.
authors.affiliation: Stem Cell Transplantation Division, National Cancer Center Hospital, 5-5-5 Tsukiji, Chuo-ku, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kurosawa
authors.forename: K
authors.initials: K
authors.lastname: Yakushijin
authors.forename: T
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Atsuta
authors.forename: T
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.forename: H
authors.initials: H
authors.lastname: Akiyama
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: K
authors.initials: K
authors.lastname: Miyamura
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: T
authors.initials: T
authors.lastname: Eto
authors.forename: H
authors.initials: H
authors.lastname: Ogawa
authors.forename: M
authors.initials: M
authors.lastname: Kurokawa
authors.forename: J
authors.initials: J
authors.lastname: Tanaka
authors.forename: K
authors.initials: K
authors.lastname: Kawa
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: R
authors.initials: R
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Morishima
authors.forename: H
authors.initials: H
authors.lastname: Sakamaki
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007938:Leukemia / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000401:mortality; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult