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Allografting

Changes in incidence and causes of non-relapse mortality after allogeneic hematopoietic cell transplantation in patients with acute leukemia/myelodysplastic syndrome: an analysis of the Japan Transplant Outcome Registry

Bone Marrow Transplantation volume 48, pages 529–536 (2013)Cite this article

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Abstract

The outcomes for allogeneic hematopoietic cell transplantation (allo-HCT) are heavily influenced by non-relapse mortality (NRM). We retrospectively assessed the changes in the incidence and causes of NRM after allo-HCT over the past 12 years. NRM, relapse rate and OS were analyzed using the Japan transplant outcome database of 6501 adult patients with acute leukemia or myelodysplastic syndrome who received their first allo-HCT in remission from 1997 through 2008. In multivariate analysis in patients aged 16–49 years, the adjusted hazard ratios (HRs) for NRM for 2001–2004 and 2005–2008 were 0.78 (95% confidence interval, 0.65–0.93) and 0.64 (0.54–0.78), respectively, compared with 1997–2000. The HR for overall mortality in 2005–2008 was 0.81 (0.70–0.93) compared with 1997–2000. In patients aged 50–70 years, the HRs for NRM and overall mortality in 2005–2008 were 0.56 (0.46–0.68) and 0.66 (0.47–0.93), respectively, compared with those in 2001–2004. We found that causes of death that contributed to the changes in NRM varied among subgroups. In conclusion, our study indicated that the incidence of NRM after allo-HCT has significantly decreased over the past 12 years, which has led to an improvement of OS, and also showed reductions in NRM in subgroups consisting of older patients and those who received unrelated cord blood transplantation.

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Acknowledgements

This work was supported by grants from the Japanese Ministry of Health, Labour and Welfare, and the National Cancer Research and Development Fund (23-A-28). The results were presented at the 52nd Annual Meeting of the American Society of Hematology in Orlando, FL, USA, 7 December 2010.

Author contributions: SK designed the study, prepared the data file, performed the analysis, interpreted the data and wrote the manuscript; KY contributed to the study design, data file preparation, data analysis and interpretation of the data; TY was primarily responsible for the study design, data analysis and interpretation of the data; YA reviewed and cleaned the data, interpreted the data and helped to write the manuscript; TNI reviewed, cleaned and interpreted the data, HA, ST, KM, ST, TE, HO and MK obtained and interpreted the data; JT, KK, KK, RS, YM and HS reviewed, cleaned and interpreted the data; TF designed the study, interpreted the data and helped to write the manuscript.

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Authors and Affiliations

  1. Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    S Kurosawa & T Fukuda

  2. Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    K Yakushijin

  3. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan

    T Yamaguchi

  4. Department of HSCT Data Management/Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta & R Suzuki

  5. Department of Cell Processing and Transfusion, The Institute of Medical Science, University of Tokyo, Tokyo, Japan

    T Nagamura-Inoue

  6. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    H Akiyama & H Sakamaki

  7. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    S Taniguchi

  8. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Miyamura

  9. Department of Hematology and Oncology, The Institute of Medical Science, University of Tokyo, Tokyo, Japan

    S Takahashi

  10. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    T Eto

  11. Department of Internal Medicine, Division of Hematology, Hyogo College of Medicine, Hyogo, Japan

    H Ogawa

  12. Department of Haematology & Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    M Kurokawa

  13. Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan

    J Tanaka

  14. Department of Hematology and Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    K Kawa

  15. Division of Haematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Kato

  16. Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan

    Y Morishima

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  1. S Kurosawa
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  9. S Takahashi
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  10. T Eto
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  12. M Kurokawa
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  13. J Tanaka
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  14. K Kawa
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  15. K Kato
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  16. R Suzuki
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  17. Y Morishima
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  18. H Sakamaki
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  19. T Fukuda
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Corresponding author

Correspondence to T Fukuda.

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Kurosawa, S., Yakushijin, K., Yamaguchi, T. et al. Changes in incidence and causes of non-relapse mortality after allogeneic hematopoietic cell transplantation in patients with acute leukemia/myelodysplastic syndrome: an analysis of the Japan Transplant Outcome Registry. Bone Marrow Transplant 48, 529–536 (2013). https://doi.org/10.1038/bmt.2012.172

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