Prognostic Factors on the Graft-versus-Host Disease-Free and Relapse-Free Survival after Adult Allogeneic Hematopoietic Stem Cell Transplantation.
The cure of hematologic disorders by allogeneic hematopoietic stem cell transplantation (HSCT) is often associated with major complications resulting in poor outcome, including graft-versus-host disease (GVHD), relapse, and death. A novel composite endpoint of GVHD-free/relapse-free survival (GRFS) in which events include grades 3-4 acute GVHD, chronic GVHD requiring systemic therapy, relapse, or death is censored to completely characterize the survival without mortality or ongoing morbidity. In this regard, studies attempting to identify the prognostic factors of GRFS are quite scarce. Thus, we reviewed 377 adult patients undergoing allogeneic HSCT between 2003 and 2013. The 1- and 2-year GRFS were 40.8% and 36.5%, respectively, significantly worse than overall survival and disease-free survival (log-rank p < 0.001). European Group for Blood and Marrow Transplantation (EBMT) risk score > 2 (p < 0.001) and hematologic malignancy (p = 0.033) were poor prognostic factors for 1-year GRFS. For 2-year GRFS, EBMT risk score > 2 (p < 0.001), being male (p = 0.028), and hematologic malignancy (p = 0.010) were significant for poor outcome. The events between 1-year GRFS and 2-year GRFS predominantly increased in relapsed patients. With prognostic factors of GRFS, we could evaluate the probability of real recovery following HSCT without ongoing morbidity.
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Yao-Chung
YC
Liu
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taitung Branch, Taitung City, Taitung County 95059, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Sheng-Hsuan
SH
Chien
Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
Nai-Wen
NW
Fan
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; Department of Medicine, Cardinal Tien Hospital, New Taipei City 23148, Taiwan.
Ming-Hung
MH
Hu
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Jyh-Pyng
JP
Gau
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Chia-Jen
CJ
Liu
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Yuan-Bin
YB
Yu
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Liang-Tsai
LT
Hsiao
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Tzeon-Jye
TJ
Chiou
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Cheng-Hwai
CH
Tzeng
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Po-Min
PM
Chen
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Jin-Hwang
JH
Liu