Journal article
Risk Score for the Development of Veno-Occlusive Disease after Allogeneic Hematopoietic Cell Transplant
Biology of blood and marrow transplantation, Vol.24(10), pp.2072-2080
10/2018
DOI: 10.1016/j.bbmt.2018.06.013
PMCID: PMC6239945
PMID: 29928989
Abstract
•The incidence of VOD was 4.86% in allogeneic transplant patients.•Age, conditioning regimen, and disease type contributed to risk of VOD.•Sirolimus use, performance status, and hepatitis B status also contributed to risk.•A risk score based on pretransplant clinical factors was developed and validated.•The highest risk cohort of patients had incidence of VOD of 14.3% to 17.8%.
A risk score identifying patients at high risk for veno-occlusive disease (VOD) may aid efforts to study preventive strategies for this uncommon complication of hematopoietic cell transplantation (HCT). Patients receiving a first allogeneic HCT between 2008 and 2013 as reported to the Center for International Blood and Marrow Transplant Research (N = 13,097) were randomly divided into training and validation sets. Independent prognostic factors for development of VOD by day +100 after HCT were identified with a multivariate logistic regression model. A risk score was constructed in the training set using the significant factors and confirmed in the validation set. Baseline characteristics of the training and validation sets were balanced. In total, 637 patients (4.9%) developed VOD by day +100. Younger age, positive hepatitis B/C serology, lower Karnofsky performance scale score, use of sirolimus, disease, disease status at transplant, and conditioning regimen were independent prognostic factors. Myeloablative conditioning regimens were associated with higher risk of VOD. Busulfan-based myeloablative conditioning regimens guided by pharmacokinetic monitoring were associated with higher risk than those without pharmacokinetic monitoring. Patients were stratified into 4 distinct, statistically significantly different groups by their risk score percentile. This pretransplant risk score successfully stratified allogeneic HCT patients by risk of developing VOD, was validated in an independent set, and demonstrated strong discriminatory ability to identify a high-risk cohort.
Details
- Title: Subtitle
- Risk Score for the Development of Veno-Occlusive Disease after Allogeneic Hematopoietic Cell Transplant
- Creators
- Christopher Strouse - University of IowaYing Zhang - Medical College of WisconsinMei-Jie Zhang - Medical College of WisconsinAlyssa DiGilio - Medical College of WisconsinMarcelo Pasquini - Medical College of WisconsinMary M. Horowitz - Medical College of WisconsinStephanie Lee - Fred Hutch Cancer CenterVincent Ho - Dana-Farber Cancer InstituteMuthalagu Ramanathan - UMass Memorial Medical CenterWichai Chinratanalab - Vanderbilt University Medical CenterAlison Loren - University of PennsylvaniaLinda J. Burns - National Marrow Donor ProgramAndrew Artz - University of ChicagoKathleen F. Villa - Jazz Pharmaceuticals (United States)Wael Saber - Medical College of Wisconsin
- Resource Type
- Journal article
- Publication Details
- Biology of blood and marrow transplantation, Vol.24(10), pp.2072-2080
- DOI
- 10.1016/j.bbmt.2018.06.013
- PMID
- 29928989
- PMCID
- PMC6239945
- NLM abbreviation
- Biol Blood Marrow Transplant
- ISSN
- 1083-8791
- eISSN
- 1523-6536
- Publisher
- Elsevier Inc
- Grant note
- DOI: 10.13039/100000102, name: Health Resources and Services Administration, award: N00014-17-1-2388, N00014-16-1-2020
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359851802771
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