Risk score for outcome after allogeneic hematopoietic stem cell transplantation

A Retrospective Analysis

Authors

  • Alois Gratwohl MD,

    Corresponding author
    1. Department of Hematology, University Hospital, University of Basel, Basel, Switzerland
    • Hematology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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    • Fax: (011) 41 61 265 42 54

  • Martin Stern MD,

    1. Department of Hematology, University Hospital, University of Basel, Basel, Switzerland
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  • Ronald Brand,

    1. Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands
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  • Jane Apperley MD,

    1. Department of Hematology, Hammersmith Hospital, London, United Kingdom
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  • Helen Baldomero,

    1. Department of Hematology, University Hospital, University of Basel, Basel, Switzerland
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  • Theo de Witte MD,

    1. Department of Hematology,University Medical Center St. Radboud, Nijmegen, Netherlands
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  • Giorgio Dini MD,

    1. Department of Pediatric Hematology and Oncology, Institute G. Gaslini, Genova, Italy
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  • Vanderson Rocha MD,

    1. Department of Hematology, St. Louis Hospital, Paris, France
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  • Jakob Passweg MD,

    1. Division of Hematology, Department of Internal Medicine, University Hospital, Geneva, Switzerland
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  • Anna Sureda MD,

    1. Clinical Hematology unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain
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  • André Tichelli MD,

    1. Department of Hematology, University Hospital, Basel, Switzerland
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  • Dietger Niederwieser MD,

    1. Division of Hematology and Oncology, University Hospital, Leipzig, Germany
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  • for the European Group for Blood and Marrow Transplantation and the European Leukemia Net

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    • Alois Gratwohl, Martin Stern, Ronald Brand, and Helen Baldomero represent the European Group for Blood and Marrow Transplantation Activity Survey Office; Theo de Witte represents the Chronic Leukemia Working Party; Giorgio Dini represents the Pediatric Working Party; Vanderson Rocha represents the Acute Leukemia Working Party and the Eurocord Office; Jakob Passweg represents the Aplastic Anemia Working Party; Anna Sureda represents the Lymphoma Working Party; André Tichelli represents the Working Party Late Effects; Dietger Niederwieser is the President of the European Group for Blood and Marrow Transplantation.


Abstract

BACKGROUND:

It was investigated whether the European Group for Blood and Marrow Transplantation risk score, previously established for chronic myeloid leukemia, could be used to predict outcome after allogeneic hematopoietic stem cell transplantation (HSCT) for hematological disease in general.

METHODS:

Age of patient, disease stage, time interval from diagnosis to transplant, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points. Its validity was tested in 56,505 patients, 33,113 (58%) male, 23,392 female, median age 33 years (range, 0.5-77 years), with an allogeneic HSCT for a hematological disorder between 1980 and 2005.

RESULTS:

Survival probability at 5 years decreased from 71% (95% confidence interval [CI], 69%-73%) for risk score 0 for the whole cohort (75%, 95% CI, 72%-78% for the most recent time cohort) to 24% (95% CI, 21%-27% for risk score 6 and 7; 25%, 95% CI, 22%-29% most recent cohort). Transplant-related mortality increased from 15% (95% CI, 14%-17%) for risk score 0 (11%, 95% CI, 9%-13%, most recent cohort) to 47% with risk score 6 and 7 (95% CI, 44%-50%) for the whole cohort (45%, 95% CI, 42%-48%, most recent cohort). The risk score was predictive in all disease categories, over all time periods, and was not altered by transplant techniques.

CONCLUSIONS:

Five well-defined pretransplant patient and donor characteristics give a reasonable risk estimate of allogeneic HSCT. This risk score can provide a basis for the decision between transplant and nontransplant strategies. Cancer 2009. © 2009 American Cancer Society.

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