Prognostic factors in salvage transplantation for graft failure following allogeneic hematopoietic stem cell transplantation

Kaito Harada, Shun ichi Kimura, Shigeo Fuji, Yuho Najima, Kimikazu Yakushijin, Naoyuki Uchida, Makoto Onizuka, Kazuhiro Ikegame, Shingo Yano, Naoki Shingai, Ken ichi Matsuoka, Yasushi Onishi, Masashi Sawa, Satoru Takada, Toshiro Kawakita, Takahiro Fukuda, Junya Kanda, Yoshiko Atsuta, Hideaki Nakasone

Research output: Contribution to journalArticlepeer-review

Abstract

Although graft failure (GF) is a fatal complication after allogeneic stem cell transplantation (SCT), no mortality risk assessments after salvage SCT have been reported. We developed a comprehensive prognostic scoring system consisting of patient and comorbidity factors with 470 patients as a training cohort out of 940; these patients underwent salvage SCT for GF. The multivariate analysis demonstrated that older age, poorer performance status, a continuation of antimicrobial treatment, and severe organ dysfunction were independently associated with worse overall survival (OS) and non-relapse mortality (NRM). Based on each factor’s hazard ratio, weighted scores of 1–3 were assigned to these factors. Using the summed scores (0–8), a prognostic scoring system successfully stratified outcomes after salvage SCT in the cohort. For patients in the low (0–2, n = 122), intermediate (3–4, n = 209), and high score (5–8, n = 110) groups, the 1-year OS was 62.8%, 40.8%, and 14.2%, respectively (P < 0.001), whereas the 1-year NRM was 24.1%, 43.9%, and 72.7%, respectively (P < 0.001). The prognostic value of the scoring system was confirmed in the validation cohort (n = 470). Our scoring system is useful for predicting survival after salvage SCT.

Original languageEnglish
Pages (from-to)2183-2193
Number of pages11
JournalBone Marrow Transplantation
Volume56
Issue number9
DOIs
Publication statusPublished - 2021 Sep

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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