The Analysis of Failure Times in the Presence of Competing Risks

Prentice, Ross L.; Kalbfleisch, John D.; Peterson, Arthur V.; Flournoy, Nancy; Farewell, Vernon; Breslow, Norman E.

doi:10.2307/2530374

Cited by 1,370 publications

(993 citation statements)

References 37 publications

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“…19 Factors associated with outcomes were analyzed using proportional-hazard or cause-specific hazard models. 20 The proportional Abbreviations: aHR = adjusted HR; CI = confidence interval; CIF = cumulative incidence function; CS = corticosteroids; EBMT = European Group for Blood and Marrow Transplantation; HR = hazard ratio; MAC = myeloablative conditioning; MMF = mycophenolate mofetil; RIC = reduced-intensity conditioning. Abbreviations: aHR = adjusted HR; CI = confidence interval; CIF = cumulative incidence function; CS = corticosteroids; EBMT = European Group for Blood and Marrow Transplantation; HR = hazard ratio; MAC = myeloablative conditioning; MMF = mycophenolate mofetil; NE = non-estimable; NPH = non-proportional hazard; RIC = reduced-intensity conditioning.…”

Section: Discussionmentioning

confidence: 99%

Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML

Sébert

Porcher

Robin

et al. 2014

Bone Marrow Transplant

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Allogeneic hematopoietic stem cell transplantation provides the best chance of long-term survival for patients with AML, but is associated with an unpredictable risk of treatment-related mortality. From January 2000 to December 2010, we compared the outcomes for patients with AML aged 35 and over using reduced-intensity conditioning (RIC, N = 60) or conventional myeloablative conditioning (MAC) regimen (N = 72) transplantation. The median follow-up was 47 months (10-134). The 4-year cumulative incidence of non-relapse mortality was 21%. After adjusting for cytogenetic risk, gender donor/recipient mismatch and CD34+ cells, non-relapse mortality was significantly lower with the RIC regimen (P = 0.027). The 4-year cumulative incidence of relapse was 38% and no difference was observed in the adjusted relapse rate between the two groups. The 4-year OS rate was 46%. Using both Cox regression and inverse probability-of-treatment weighted (IPTW) method, a similar OS rate was found with both regimens (adjusted hazard ratios for conventional vs reduced of 1.14 (95% CI 0.67-1.93, P = 0.64) with Cox regression, and 1.14 (95% CI 0.55-2.34, P = 0.73) with IPTW). Until prospective trials are completed, this study supports the use of a reduced-intensity regimen prior to transplantation for patients with AML aged 35 and over. INTRODUCTIONAllogeneic hematopoietic stem cell transplantation (HSCT) provides the best chance for long-term survival and offers the lowest risk of relapse for patients with high-risk AML. 1 Advances in genomic technologies have identified AML as a genetically heterogenous disease: many patients can now be classified into prognostic subgroups on the basis of their underlying molecular genetic defects, 2 although the indication for HSCT in all intermediate-risk patients in first remission of AML is still debated. 3 The major limitation of HSCT is the risk of treatment-related mortality (TRM), especially among older candidates with comorbidities. 4 As the incidence of AML is highest in people older than 60, reduced-intensity conditioning (RIC) regimens have been developed for over a decade in order to decrease TRM. 5 These regimens are now increasingly used to facilitate HSCT in patients with advanced age or medical comorbidities, primarily because RIC regimens are well tolerated and are associated with less toxicity. 6,7 Previously published retrospective analyses suggested similar survival rates, but with a significantly higher risk of relapse after RIC regimen for patients aged 50 and over with AML 8 or for patients with myelodysplastic syndromes. 9 Using unrelated donors (URDs), another retrospective study reported a higher relapse rate in AML patients younger than 50 years after RIC regimen, with a similar leukemia-free survival between the two regimens. 10

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Section: Discussionmentioning

confidence: 99%

Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML

Sébert

Porcher

Robin

et al. 2014

Bone Marrow Transplant

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“…43,44 Finally, our model assumes independence between death from prostate cancer and causes other than prostate cancer, a condition that may be violated through comorbidity. 45,46 …”

Section: Limitationsmentioning

confidence: 99%

Explaining racial differences in prostate cancer mortality

Taksler

Keating

Cutler

2012

Cancer

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BACKGROUND:In the United States, black males have an annual death rate from prostate cancer that is 2.4 times that of white males. The reasons for this are poorly understood. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, 77,038 black and white males aged >65 years were identified with a first primary diagnosis of prostate cancer between 1995 and 2005, as well as 49,769 controls. The racial gap in mortality was decomposed to differential incidence and stage-specific prostate cancer mortality. The importance of various clinical and socioeconomic factors to each of these components was then examined. RESULTS: The estimated mortality gap for prostate cancer-specific mortality was 1320 more cases per 100,000 males among black than white men. This gap was due to higher prostate cancer incidence among black males (76%) and higher stage-specific mortality once diagnosed (24%). Differences in prostate-specific antigen testing, comorbidities, and income explained 29% of the difference in metastatic cancer incidence but none of the racial gap for local/regional incidence. Conditional on diagnosis, tumor characteristics explained 50% of the racial gap, comorbidities an additional 4%, choice of treatment and physician 17%, and socioeconomic factors 15%. Overall, approximately 25% of the racial gap in mortality and 86% of the gap in mortality conditional on diagnosis could be explained. CONCLUSIONS: More frequent prostate-specific antigen testing for black and low-income males could potentially reduce the prostate cancer mortality gap through earlier diagnosis of tumors that otherwise may become metastatic. More aggressive treat-

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“…Factors associated with outcomes were analyzed using logistic regression (for engraftment), proportional hazard models for cause-specific hazards (aGVHD, cGVHD, NRM and relapse) [23], and Cox proportional hazard models (OS) [24]. 10/10-HLA MUD was considered to be the reference group in the analyses.…”

Section: Introductionmentioning

confidence: 99%

Impact of the source of hematopoietic stem cell in unrelated transplants: Comparison between 10/10, 9/10‐HLAmatched donors and cord blood

et al. 2015

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In absence of available matched-related or unrelated donor (MUD), mismatched unrelated donors (MMUD) and unrelated cord blood (UCB) are both considered to be suitable donors, with similar post-transplant overall survival. In most of these retrospective comparisons, HLA typing of adult donors was performed at eight loci. The aim of this study was to compare the outcome of patients transplanted from UCB (N 5 64) with those transplanted from 9/10-HLA MMUD (N 5 84) or 10/10-HLA MUD (N 5 196). In multivariate analysis, UCB was associated with less Grade II-IV acute GVHD in comparison with MUD (aHR 1.97, 95% CI 1.19-3.27, P 5 0.009) and MMUD transplants (aHR 1.79, 95% CI 1.02-3.15, P 5 0.042), while the cumulative incidence of chronic GVHD was not significantly different between the three groups. Overall survival (OS), non-relapse mortality, and relapse were not different between MMUD and UCB transplantation, whereas OS was impaired after UCB in comparison with MUD (aHR 0.65, 95% CI 0.43-0.99, P 5 0.043). Factors also impacting OS were the donor/recipient CMV serostatus (Donor2/Recipient1 aHR 1.76, 95% CI 1.23-2.52, P 5 0.002 compared with D2/R2), the donor/recipient gender combination (Female/Male versus other combinations aHR 1.57, 95% CI 1.11-2.22, P 5 0.012) and disease risk (aHR 1.58, 95% CI 1.05-2.38, P 5 0.027 for high vs. low risk disease). Our data confirm that UCB and 9/10-HLA MMUD are both relevant alternative options when no 10/10-HLA donor is available. Donor/recipient gender combination and CMV serostatus had a significant impact on survival and may be taken into account, along with donor type, in the setting of MMUD and UCB transplants.

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The Analysis of Failure Times in the Presence of Competing Risks

Cited by 1,370 publications

References 37 publications

Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML

Equivalent outcomes using reduced intensity or conventional myeloablative conditioning transplantation for patients aged 35 years and over with AML

Explaining racial differences in prostate cancer mortality

Impact of the source of hematopoietic stem cell in unrelated transplants: Comparison between 10/10, 9/10‐HLAmatched donors and cord blood

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