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The Impact of Toxicities on First-Year Outcomes after Ex Vivo CD34+-Selected Allogeneic Hematopoietic Cell Transplantation in Adults with Hematologic Malignancies.


ABSTRACT: Factors that impact first-year morbidity and mortality in adults undergoing myeloablative allogeneic hematopoietic cell transplantation with ex vivo CD34+ selection have not been previously reported. We assessed all toxicities ? grade 3 from the start of conditioning to date of death, relapse, or last contact in 200 patients during the first year after transplantation, identifying 1885 individual toxicities among 17 organ-based toxicity groups. The most prevalent toxicities in the first year were of infectious, metabolic, hematologic, oral/gastrointestinal, hepatic, cardiac, and pulmonary etiologies. Renal complications were minimal. Grades II to IV and III and IV acute GVHD at day 100 were 11.5% and 3%, respectively. In separate multivariate models, cardiovascular, hematologic, hepatic, neurologic, pulmonary, and renal toxicities negatively impacted nonrelapse mortality (NRM) and overall survival during the first year. A higher-than-targeted busulfan level, patient cytomegalovirus seropositivity, and an Hematopoietic Cell Transplantation-Specific Comorbidity Index of ?3 were associated with increased risk of NRM and all-cause death. Ex vivo CD34+ selection had a favorable 1-year OS of 75% and NRM of 17% and a low incidence of sinusoidal obstruction syndrome. These data establish a benchmark to focus efforts in reducing toxicity burden while improving patient outcomes.

SUBMITTER: Kosuri S 

PROVIDER: S-EPMC7376603 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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The Impact of Toxicities on First-Year Outcomes after Ex Vivo CD34<sup>+</sup>-Selected Allogeneic Hematopoietic Cell Transplantation in Adults with Hematologic Malignancies.

Kosuri Satyajit S   Adrianzen Herrera Diego D   Scordo Michael M   Shah Gunjan L GL   Cho Christina C   Devlin Sean M SM   Maloy Molly A MA   Nieves Jimmy J   Borrill Taylor T   Carlow Dean C DC   Avecilla Scott T ST   Meagher Richard C RC   O'Reilly Richard J RJ   Papadopoulos Esperanza B EB   Jakubowski Ann A AA   Koehne Guenther G   Gyurkocza Boglarka B   Castro-Malaspina Hugo H   Shaffer Brian C BC   Tamari Roni R   Giralt Sergio A SA   Perales Miguel-Angel MA  

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation 20170718 11


Factors that impact first-year morbidity and mortality in adults undergoing myeloablative allogeneic hematopoietic cell transplantation with ex vivo CD34<sup>+</sup> selection have not been previously reported. We assessed all toxicities ≥ grade 3 from the start of conditioning to date of death, relapse, or last contact in 200 patients during the first year after transplantation, identifying 1885 individual toxicities among 17 organ-based toxicity groups. The most prevalent toxicities in the fir  ...[more]

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