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2014 ; 124
(2
): 287-95
Nephropedia Template TP
gab.com Text
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Pretransplant comorbidities predict severity of acute graft-versus-host disease
and subsequent mortality
#MMPMID24797298
Sorror ML
; Martin PJ
; Storb RF
; Bhatia S
; Maziarz RT
; Pulsipher MA
; Maris MB
; Davis C
; Deeg HJ
; Lee SJ
; Maloney DG
; Sandmaier BM
; Appelbaum FR
; Gooley TA
Blood
2014[Jul]; 124
(2
): 287-95
PMID24797298
show ga
Whether the hematopoietic cell transplantation comorbidity index (HCT-CI) can
provide prognostic information about development of acute graft-versus-host
disease (GVHD) and subsequent mortality is unknown. Five institutions contributed
information on 2985 patients given human leukocyte antigen-matched grafts to
address this question. Proportional hazards models were used to estimate the
hazards of acute GVHD and post-GVHD mortality after adjustment for known risk
variables. Higher HCT-CI scores predicted increased risk of grades 3 to 4 acute
GVHD (P < .0001 and c-statistic of 0.64), and tests of interaction suggested that
this association was consistent among different conditioning intensities, donor
types, and stem cell sources. Probabilities of grades 3 to 4 GVHD were 13%, 18%,
and 24% for HCT-CI risk groups of 0, 1 to 4, and ?5. The HCT-CI was statistically
significantly associated with mortality rates following diagnosis of grade 2
(hazard ratio [HR] = 1.24; P < .0001) or grades 3 to 4 acute GVHD (HR = 1.19; P <
.0001). Patients with HCT-CI scores of ?3 who developed grades 3 to 4 acute GVHD
had a 2.63-fold higher risk of mortality than those with scores of 0 to 2 and did
not develop acute GVHD. Thus, pretransplant comorbidities are associated with the
development and severity of acute GVHD and with post-GVHD mortality. The HCT-CI
could be useful in designing trials for GVHD prevention and could inform
expectations for GVHD treatment trials.
|*Hematopoietic Stem Cell Transplantation/adverse effects/statistics & numerical
data
[MESH]
|Adolescent
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Comorbidity
[MESH]
|Graft vs Host Disease/*diagnosis/etiology/*mortality
[MESH]