Allografting

Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia

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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.

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Acknowledgements

This work was supported by grants from the Japanese Ministry of Health, Labor 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, 7 December, 2010.

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Correspondence to T Fukuda.

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The authors declare no conflicts of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Keywords

  • allogeneic hematopoietic cell transplantation
  • acute leukemia
  • non-remission
  • non-relapse mortality
  • GVHD

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