Preemptive Bone Marrow Transplantation and Event-Free Survival in Fanconi Anemia

Nicholas E. Khan, Philip S. Rosenberg, Blanche P. Alter

Research output: Contribution to journalArticle

Abstract

Fanconi anemia (FA) is a rare inherited bone marrow failure syndrome associated with high risks of severe bone marrow failure (BMF), acute myeloid leukemia (AML), and solid tumors (ST). Bone marrow transplantation (BMT) provides a theoretical cure for hematologic risks (BMF, AML), but it introduces uncertain risks of transplantation-related mortality (TRM) and carcinogenicity. We developed a mathematical (Markov) decision model to estimate event-free survival (EFS) conditional on age based on per-year cause-specific hazard rates. We assumed that preemptive (PE) BMT eliminates the risks of BMF and AML, but it may introduce independent risks of TRM or influence the trajectory to ST. Our model suggested that the expected mean EFS in FA is higher for PE-BMT at young ages, with minimal risk of TRM and with little carcinogenicity. PE-BMT in adults decreased expected EFS because of the greater competing risk of ST in adulthood. Estimates of EFS conditioned on attained age may be used in shared decision-making when clinicians must counsel patients using limited data. Our methods may be used to model early transplantation in other blood disorders for which hematopoietic stem cell transplantation mitigates some but not all of the risks.

Original languageEnglish (US)
Pages (from-to)1888-1892
Number of pages5
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • Decision analysis
  • Fanconi anemia
  • Markov model
  • Preemptive transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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