title: Providing personalized prognostic information for adult leukemia survivors.
abstract: Prediction of subsequent leukemia-free survival (LFS) and chronic graft-versus-host disease (GVHD) in adults with acute leukemia who survived at least 1 year after allogeneic hematopoietic cell transplantation is difficult. We analyzed 3339 patients with acute myeloid leukemia and 1434 patients with acute lymphoblastic leukemia who received myeloablative conditioning and related or unrelated stem cells from 1990 to 2005. Most clinical factors predictive of LFS in 1-year survivors were no longer significant after 2 or more years. For acute myeloid leukemia, only disease status (beyond first complete remission) remained a significant adverse risk factor for LFS 2 or more years after transplantation. For lymphoblastic leukemia, only extensive chronic GVHD remained a significant adverse predictor of LFS in the second and subsequent years. For patients surviving for 1 year without disease relapse or extensive chronic GVHD, the risk of developing extensive chronic GVHD in the next year was 4% if no risk factors were present and higher if noncyclosporine-based GVHD prophylaxis, an HLA-mismatched donor, or peripheral blood stem cells were used. Estimates for subsequent LFS and extensive chronic GVHD can be derived for individual patients or populations using an online calculator (http://www.cibmtr.org/LeukemiaCalculators). This prognostic information is more relevant for survivors than estimates provided before transplantation.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington. Electronic address: sjlee@fhcrc.org.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Barry
authors.initials: B
authors.lastname: Storer
authors.forename: Hailin
authors.initials: H
authors.lastname: Wang
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.forename: Luis M
authors.initials: LM
authors.lastname: Isola
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.forename: John Bosco C
authors.initials: JB
authors.lastname: Umejiego
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.forename: Alison W
authors.initials: AW
authors.lastname: Loren
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Camitta
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: H
authors.initials: H
authors.lastname: Jean Khoury
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.forename: David A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: Edward A
authors.initials: EA
authors.lastname: Copelan
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Jane L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Alan M
authors.initials: AM
authors.lastname: Miller
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods*; D011379:Prognosis; D017741:Survivors; D055815:Young Adult
keywords: Chronic graft-versus-host disease; Landmark analysis; Leukemia-free survival; Prognosis; Survivorship
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