Reduced mortality after allogeneic hematopoietic-cell transplantation

Ted A. Gooley, Jason W. Chien, Steven A. Pergam, Sangeeta Hingorani, Mohamed L. Sorror, Michael Boeckh, Paul J. Martin, Brenda M. Sandmaier, Kieren Marr, Frederick R. Appelbaum, Rainer Storb, George B. McDonald

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation. METHODS: We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation. RESULTS: In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs. CONCLUSIONS: We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.)

Original languageEnglish (US)
Pages (from-to)2091-2101
Number of pages11
JournalNew England Journal of Medicine
Volume363
Issue number22
DOIs
StatePublished - Nov 25 2010
Externally publishedYes

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Cell Transplantation
Mortality
Graft vs Host Disease
Transplantation
Recurrence
Transplants
Kidney
Lung
Mycoses
Behavior Therapy
Liver
National Institutes of Health (U.S.)
Virus Diseases
Bacterial Infections
Patient Care
Survival
Infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gooley, T. A., Chien, J. W., Pergam, S. A., Hingorani, S., Sorror, M. L., Boeckh, M., ... McDonald, G. B. (2010). Reduced mortality after allogeneic hematopoietic-cell transplantation. New England Journal of Medicine, 363(22), 2091-2101. https://doi.org/10.1056/NEJMoa1004383

Reduced mortality after allogeneic hematopoietic-cell transplantation. / Gooley, Ted A.; Chien, Jason W.; Pergam, Steven A.; Hingorani, Sangeeta; Sorror, Mohamed L.; Boeckh, Michael; Martin, Paul J.; Sandmaier, Brenda M.; Marr, Kieren; Appelbaum, Frederick R.; Storb, Rainer; McDonald, George B.

In: New England Journal of Medicine, Vol. 363, No. 22, 25.11.2010, p. 2091-2101.

Research output: Contribution to journalArticle

Gooley, TA, Chien, JW, Pergam, SA, Hingorani, S, Sorror, ML, Boeckh, M, Martin, PJ, Sandmaier, BM, Marr, K, Appelbaum, FR, Storb, R & McDonald, GB 2010, 'Reduced mortality after allogeneic hematopoietic-cell transplantation', New England Journal of Medicine, vol. 363, no. 22, pp. 2091-2101. https://doi.org/10.1056/NEJMoa1004383
Gooley TA, Chien JW, Pergam SA, Hingorani S, Sorror ML, Boeckh M et al. Reduced mortality after allogeneic hematopoietic-cell transplantation. New England Journal of Medicine. 2010 Nov 25;363(22):2091-2101. https://doi.org/10.1056/NEJMoa1004383
Gooley, Ted A. ; Chien, Jason W. ; Pergam, Steven A. ; Hingorani, Sangeeta ; Sorror, Mohamed L. ; Boeckh, Michael ; Martin, Paul J. ; Sandmaier, Brenda M. ; Marr, Kieren ; Appelbaum, Frederick R. ; Storb, Rainer ; McDonald, George B. / Reduced mortality after allogeneic hematopoietic-cell transplantation. In: New England Journal of Medicine. 2010 ; Vol. 363, No. 22. pp. 2091-2101.
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AU - Gooley, Ted A.

AU - Chien, Jason W.

AU - Pergam, Steven A.

AU - Hingorani, Sangeeta

AU - Sorror, Mohamed L.

AU - Boeckh, Michael

AU - Martin, Paul J.

AU - Sandmaier, Brenda M.

AU - Marr, Kieren

AU - Appelbaum, Frederick R.

AU - Storb, Rainer

AU - McDonald, George B.

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N2 - BACKGROUND: Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation. METHODS: We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation. RESULTS: In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs. CONCLUSIONS: We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.)

AB - BACKGROUND: Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation. METHODS: We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation. RESULTS: In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs. CONCLUSIONS: We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.)

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