Providing Personalized Prognostic Information for Adult Leukemia Survivors

Stephanie J. Lee*, Barry Storer, Hailin Wang, Hillard M. Lazarus, Edmund K. Waller, Luis M. Isola, Thomas R. Klumpp, John Bosco C. Umejiego, Bipin N. Savani, Alison W. Loren, Mitchell S. Cairo, Bruce M. Camitta, Corey S. Cutler, Biju George, H. Jean Khoury, David I. Marks, David A. Rizzieri, Edward A. Copelan, Vikas Gupta, Jane L. LiesveldMark R. Litzow, Alan M. Miller, Harry C. Schouten, Robert Peter Gale, Jean-Yves Cahn, Daniel J. Weisdorf

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

Prediction of subsequent leukemia-free survival (LFS) and chronic graft-versus-host disease (GVHD) in adults with acute leukemia who survived at least 1 year after allogeneic hematopoietic cell transplantation is difficult. We analyzed 3339 patients with acute myeloid leukemia and 1434 patients with acute lymphoblastic leukemia who received myeloablative conditioning and related or unrelated stem cells from 1990 to 2005. Most clinical factors predictive of LFS in 1-year survivors were no longer significant after 2 or more years. For acute myeloid leukemia, only disease status (beyond first complete remission) remained a significant adverse risk factor for LFS 2 or more years after transplantation. For lymphoblastic leukemia, only extensive chronic GVHD remained a significant adverse predictor of LFS in the second and subsequent years. For patients surviving for 1 year without disease relapse or extensive chronic GVHD, the risk of developing extensive chronic GVHD in the next year was 4% if no risk factors were present and higher if noncyclosporine-based GVHD prophylaxis, an HLA-mismatched donor, or peripheral blood stem cells were used. Estimates for subsequent LFS and extensive chronic GVHD can be derived for individual patients or populations using an online calculator (http://www.cibmtr.org/LeukemiaCalculators). This prognostic information is more relevant for survivors than estimates provided before transplantation.
Original languageEnglish
Pages (from-to)1600-1607
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 2013

Keywords

  • Leukemia-free survival
  • Chronic graft-versus-host disease
  • Landmark analysis
  • Survivorship
  • Prognosis

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