Allo-HSCT Non-Relapse Related Mortality Reduction Revealed

By Lynda Williams, Senior medwireNews Reporter

A reduction in the risks of infection- and organ failure-related death has driven an improvement in non-relapse mortality (NRM) among recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT), Japanese research suggests.

Between 1998 and 2012, the rate of NRM was 16% in the 920 patients aged at least 16 years who received allo-HSCT, with overall survival of 59% after 2 years, report Saiko Kurosawa, from the National Cancer Hospital in Tokyo and co-workers.

A downward trend in 2-year rates of NRM was detected over time, with 2-year rates of 26%, 14% and 9% for 1998-2002, 2003-2007 and 2008-2012, respectively.

Changes in allo-HSCT patterns between the first and third time periods included a decrease in the proportion of patients undergoing transplantation for chronic myeloid leukaemia (16 to 1%) and the use of cyclosporine (100 to 16%).

However, there were also increases in the proportion of patients with high-risk disease (31 to 43%) and those receiving transplants from donors with unrelated bone marrow (35 to 66%).

And the reduction in NRM included both patients who were aged over 50 years and younger recipients, the team notes in Bone Marrow Transplantation.

Nevertheless, multivariate analysis demonstrated that younger age, female gender and a low haematopoietic cell transplant comorbidity index score were significantly associated with a lower risk of NRM.

Overall mortality risk was significantly lower in female patients, and those with a good performance status, a low disease risk and a good comorbidity index score, the researchers add.

Analysis also revealed that grade III-IV acute graft versus host disease (GVHD) became significantly less common over time and there was a trend towards a lower risk of chronic GVHD.

Of the 180 NR-related deaths, 28 were from undetermined causes, 11 from secondary malignancy and 10 were accidental or otherwise unrelated to HSCT. The remaining deaths were from infectious disease with (n=54) or without immunosuppressive therapy (n=22), organ failure (n=40) and GVHD (n=15).

Over the time period studied, the 2-year incidence of deaths from infectious disease with immunosuppressive therapy and from organ failure significantly fell, from 7.1% to 2.8% and 7.6% to 2.5%, respectively.

A downward trend was also noted for GVHD and infectious disease without immunosuppressive therapy but these did not reach significance.

Discussing these NR-related survival patterns, Kurosawa et al conclude: "The next step is to improve the outcomes of HSCT using newer approaches such as the use of haploidentical donors, which would further extend one of the main benefits of HSCT, namely a reduction in the risk of relapse, to a broader range of patients."

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