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The Impact of Toxicities on First-Year Outcomes after Ex Vivo CD34+-Selected Allogeneic Hematopoietic Cell Transplantation in Adults with Hematologic Malignancies.

Authors
  • Kosuri, Satyajit1
  • Adrianzen Herrera, Diego2
  • Scordo, Michael3
  • Shah, Gunjan L4
  • Cho, Christina3
  • Devlin, Sean M5
  • Maloy, Molly A3
  • Nieves, Jimmy3
  • Borrill, Taylor3
  • Carlow, Dean C6
  • Avecilla, Scott T6
  • Meagher, Richard C6
  • O'Reilly, Richard J7
  • Papadopoulos, Esperanza B4
  • Jakubowski, Ann A4
  • Koehne, Guenther4
  • Gyurkocza, Boglarka4
  • Castro-Malaspina, Hugo4
  • Shaffer, Brian C4
  • Tamari, Roni4
  • And 2 more
  • 1 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Section of Hematology/Oncology, Hematopoietic Stem Cell Transplantation Program, The University of Chicago, Chicago, Illinois. Electronic address: [email protected]
  • 2 Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
  • 3 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 4 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
  • 5 Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 6 Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
  • 7 Pediatric Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pediatrics, Weill Cornell Medical College, New York, New York.
  • 8 Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York. Electronic address: [email protected]
Type
Published Article
Journal
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Publication Date
Nov 01, 2017
Volume
23
Issue
11
Pages
2004–2011
Identifiers
DOI: 10.1016/j.bbmt.2017.07.012
PMID: 28733264
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Factors that impact first-year morbidity and mortality in adults undergoing myeloablative allogeneic hematopoietic cell transplantation with ex vivo CD34+ selection have not been previously reported. We assessed all toxicities ≥ grade 3 from the start of conditioning to date of death, relapse, or last contact in 200 patients during the first year after transplantation, identifying 1885 individual toxicities among 17 organ-based toxicity groups. The most prevalent toxicities in the first year were of infectious, metabolic, hematologic, oral/gastrointestinal, hepatic, cardiac, and pulmonary etiologies. Renal complications were minimal. Grades II to IV and III and IV acute GVHD at day 100 were 11.5% and 3%, respectively. In separate multivariate models, cardiovascular, hematologic, hepatic, neurologic, pulmonary, and renal toxicities negatively impacted nonrelapse mortality (NRM) and overall survival during the first year. A higher-than-targeted busulfan level, patient cytomegalovirus seropositivity, and an Hematopoietic Cell Transplantation-Specific Comorbidity Index of ≥3 were associated with increased risk of NRM and all-cause death. Ex vivo CD34+ selection had a favorable 1-year OS of 75% and NRM of 17% and a low incidence of sinusoidal obstruction syndrome. These data establish a benchmark to focus efforts in reducing toxicity burden while improving patient outcomes. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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