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. Liesveld; Mark R. Litzow; Alan M. Miller; Harry C. Schouten; Robert Peter Gale; Jean-Yves Cahn; Daniel J. Weisdorf

doi:10.1016/j.bbmt.2013.08.013

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 journal › Article › Academic › peer-review

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 language	English
Pages (from-to)	1600-1607
Journal	Biology of Blood and Marrow Transplantation
Volume	19
Issue number	11
DOIs	https://doi.org/10.1016/j.bbmt.2013.08.013
Publication status	Published - Nov 2013

Keywords

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

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10.1016/j.bbmt.2013.08.013Licence: CC BY-NC-ND

Cite this

Lee, S. J., Storer, B., Wang, H., Lazarus, H. M., Waller, E. K., Isola, L. M., Klumpp, T. R., Umejiego, J. B. C., Savani, B. N., Loren, A. W., Cairo, M. S., Camitta, B. M., Cutler, C. S., George, B., Khoury, H. J., Marks, D. I., Rizzieri, D. A., Copelan, E. A., Gupta, V., ... Weisdorf, D. J. (2013). Providing Personalized Prognostic Information for Adult Leukemia Survivors. Biology of Blood and Marrow Transplantation, 19(11), 1600-1607. https://doi.org/10.1016/j.bbmt.2013.08.013

@article{d394a983fede4e2f859427e435869950,

title = "Providing Personalized Prognostic Information for Adult Leukemia Survivors",

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. ",

keywords = "Leukemia-free survival, Chronic graft-versus-host disease, Landmark analysis, Survivorship, Prognosis",

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

year = "2013",

month = nov,

doi = "10.1016/j.bbmt.2013.08.013",

language = "English",

volume = "19",

pages = "1600--1607",

journal = "Biology of Blood and Marrow Transplantation",

issn = "1083-8791",

publisher = "Elsevier Science",

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Lee, SJ, Storer, B, Wang, H, Lazarus, HM, Waller, EK, Isola, LM, Klumpp, TR, Umejiego, JBC, Savani, BN, Loren, AW, Cairo, MS, Camitta, BM, Cutler, CS, George, B, Khoury, HJ, Marks, DI, Rizzieri, DA, Copelan, EA, Gupta, V, Liesveld, JL, Litzow, MR, Miller, AM, Schouten, HC, Gale, RP, Cahn, J-Y & Weisdorf, DJ 2013, 'Providing Personalized Prognostic Information for Adult Leukemia Survivors', Biology of Blood and Marrow Transplantation, vol. 19, no. 11, pp. 1600-1607. https://doi.org/10.1016/j.bbmt.2013.08.013

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T1 - Providing Personalized Prognostic Information for Adult Leukemia Survivors

AU - Lee, Stephanie J.

AU - Storer, Barry

AU - Wang, Hailin

AU - Lazarus, Hillard M.

AU - Waller, Edmund K.

AU - Isola, Luis M.

AU - Klumpp, Thomas R.

AU - Umejiego, John Bosco C.

AU - Savani, Bipin N.

AU - Loren, Alison W.

AU - Cairo, Mitchell S.

AU - Camitta, Bruce M.

AU - Cutler, Corey S.

AU - George, Biju

AU - Khoury, H. Jean

AU - Marks, David I.

AU - Rizzieri, David A.

AU - Copelan, Edward A.

AU - Gupta, Vikas

AU - Liesveld, Jane L.

AU - Litzow, Mark R.

AU - Miller, Alan M.

AU - Schouten, Harry C.

AU - Gale, Robert Peter

AU - Cahn, Jean-Yves

AU - Weisdorf, Daniel J.

PY - 2013/11

Y1 - 2013/11

N2 - 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.

AB - 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.

KW - Leukemia-free survival

KW - Chronic graft-versus-host disease

KW - Landmark analysis

KW - Survivorship

KW - Prognosis

U2 - 10.1016/j.bbmt.2013.08.013

DO - 10.1016/j.bbmt.2013.08.013

M3 - Article

C2 - 24018394

SN - 1083-8791

VL - 19

SP - 1600

EP - 1607

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

IS - 11

ER -