What are the most important donor and recipient factors affecting the outcome of related and unrelated allogeneic transplantation?

Anasetti, Claudio

doi:10.1016/j.beha.2008.10.002

Cited by 41 publications

(27 citation statements)

References 22 publications

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“…Increased age has previously been shown to be a risk factor for SCT recipients, [20][21][22] and it was a statistically significant risk factor for development of PEF in this study. We evaluated age as a continuous variable with increased risk as age increased.…”

Section: Discussionsupporting

confidence: 48%

Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease

Neier

Jin

Kleinman

et al. 2010

Bone Marrow Transplant

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The objective of this study was to assess the incidence, risk factors, outcome and impact on OS of pericardial effusion (PEF) in a cohort of 156 pediatric SCT recipients. The mean age was 8.15 ± 6.25 years. In all, 74% of the patients had malignant disease and 35% of the patients received autologous stem cell grafts. Twenty-three subjects developed effusion at 2.75 ± 3.54 months after SCT. The overall probability of developing a PEF after SCT was 16.9%. In the multivariate analysis of risk factors associated with time to PEF, increased age, allogeneic risk status and conditioning type, were all significant factors. In a multivariate analysis of time to death, PEF, CMV status and risk status were all independent risk factors. PEF, however, had the highest HR of 3.334. Of the 23 patients with PEF, 19 died (82.6%); however, none died as a direct result of pericardial tamponade. In summary, our results suggest that PEF is a significant risk factor for post transplant mortality. These results suggest a need for more frequent evaluation and monitoring for development of PEF. Studies are needed to determine the etiology of, and new therapeutic strategies for, PEF in the post-SCT population.

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Section: Discussionsupporting

confidence: 48%

Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease

Neier

Jin

Kleinman

et al. 2010

Bone Marrow Transplant

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“…Other factors that might influence risks for NRM and overall mortality and should be taken into account include recipient CMV serology status and number of prior chemotherapy regimens. 47 Several single nucleotide polymorphisms (SNPs) were found to be associated with critical post-HCT morbidities and thus mortality. 82,83 The use of SNPs in pre-HCT risk assessment will require further validation, but can potentially improve our methods to select appropriate candidates for allogeneic HCT.…”

Section: Other Important Variablesmentioning

confidence: 99%

Allogeneic hematopoietic cell transplantation for acute myeloid leukemia in older adults

Sorror

Estey

2014

Hematology

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Acute myeloid leukemia (AML) is primarily a disease of the elderly and the numbers of these patients are increasing. Patients Ն60 years of age continue to have poor prognosis. Preliminary results suggest benefit from reduced-intensity allogeneic hematopoietic cell transplantation (HCT) in selected patients 60-80 years of age. However, although patients in this age range comprise Ͼ50% of those with AML, they currently constitute only 17% of those offered HCT. In the absence of prospective randomized studies comparing HCT and chemotherapy, the decision to recommend HCT rests on retrospective analyses of the risks of relapse and nonrelapse mortality after each approach. There is strong evidence that pre-HCT comorbidities can predict HCT-related morbidity and mortality. Age alone does not appear predictive and, particularly if the risk of relapse with chemotherapy is high, should not be the sole basis for deciding against HCT. Use of geriatric assessment tools, inflammatory biomarkers, and genetic polymorphism data may further aid in predicting nonrelapse mortality after HCT. Disease status and pretreatment cytogenetics with FLT3-TID, NPM-1, and CEBP-␣ status are the main factors predicting relapse and these are likely to be supplemented by incorporation of other molecular markers and the level of minimal residual disease after chemotherapy. HLA-matched related and unrelated donor grafts seem preferable to those from other donor sources. Donor age is of no clear significance. Models combining comorbidities with AML risk factors are useful in risk assessment before HCT. In this chapter, we integrated information on AML-specific, HCT-specific, and patient-specific risk factors into a risk-adapted approach to guide decisions about HCT versus no HCT. Learning Objectives• Age per se is not a barrier to RIC followed by allogeneic HCT in patients 60-80 years of age.• Health status measures, particularly comorbidity indices, should be routinely assessed pre-HCT because they significantly affect risks for NRM.• An adapted-risk approach combining AML disease status, cytogenetics, and molecular markers, together with comorbidities and other patient risk factors, is proposed for decision making about allogeneic HCT for older patients.

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“…The lower admission rates after AutoSCT are likely due to less frequent pulmonary post-transplant complications compared to AlloSCT [19] . The reported risk factors for ICU admission among AlloSCT patients are myeloablative conditioning, acute graft-versus-host disease (GVHD), and HLA mismatch between donor and recipient [9,13,14] ; all of which are transplant-related and not surprisingly also increase TRM [6,20,21] . In the only recent study that methodologically assessed the ICU admission risk factors, Benz et al [9] did not find patient age, gender, disease type or stem cell source to affect ICU admission risk.…”

Section: Factors Associated With Icu Admission Ratesmentioning

confidence: 99%

Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Bayraktar

Nates

2016

WJCO

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Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of nonbeneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients' functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pretransplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients' functional status at the time of critical illness.

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What are the most important donor and recipient factors affecting the outcome of related and unrelated allogeneic transplantation?

Cited by 41 publications

References 22 publications

Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease

Pericardial effusion post-SCT in pediatric recipients with signs and/or symptoms of cardiac disease

Allogeneic hematopoietic cell transplantation for acute myeloid leukemia in older adults

Intensive care outcomes in adult hematopoietic stem cell transplantation patients

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