Reduced Mortality after Allogeneic Hematopoietic-Cell Transplantation

• Published in: The New England journal of medicine Vol. 363; no. 22; pp. 2091 - 2101
• Main Authors: Gooley, Ted A, Chien, Jason W, Pergam, Steven A, Hingorani, Sangeeta, Sorror, Mohamed L, Boeckh, Michael, Martin, Paul J, Sandmaier, Brenda M, Marr, Kieren A, Appelbaum, Frederick R, Storb, Rainer, McDonald, George B
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 25.11.2010
• Subjects: Adolescent; Adult; Aged; Bilirubin - blood; Biological and medical sciences; Bone Marrow Diseases - mortality; Bone Marrow Diseases - therapy; Child; Child, Preschool; Creatinine - blood; Cytomegalovirus; Drug dosages; Epidemiology; Fungal infections; General aspects; Graft vs Host Disease - epidemiology; Graft vs Host Disease - mortality; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - mortality; Humans; Infant; Infection - epidemiology; Infection - etiology; Kidney Diseases - epidemiology; Kidney Diseases - etiology; Leukemia - mortality; Leukemia - therapy; Liver Diseases - epidemiology; Liver Diseases - etiology; Lung Diseases - epidemiology; Lung Diseases - etiology; Lymphoma, Non-Hodgkin - mortality; Lymphoma, Non-Hodgkin - therapy; Medical sciences; Middle Aged; Mortality; Mortality - trends; Multiple Myeloma - mortality; Multiple Myeloma - therapy; Myelodysplastic Syndromes - therapy; Nosocomial infections; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recurrence; Transplantation, Homologous - mortality; Transplants & implants; Young Adult; Medicine; Reduction; Allogeneic hematopoietic stem cell transplantation; Stem cell; Mortality; Hematopoietic cell; Homograft; Graft; Epidemiology
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa1004383

This comparison of outcomes of allogeneic hematopoietic stem-cell transplantation in 1993–1997 and 2003–2007 shows that although patients had a somewhat poorer overall prognosis in the more recent period, the rate of death not preceded by relapse, the risk of relapse, and overall mortality decreased. Infections, graft-versus-host disease (GVHD), and liver, kidney, and pulmonary complications have been associated with high mortality after allogeneic hematopoietic-cell transplantation since the introduction of this procedure 40 years ago. 1 Changes in practice have decreased organ toxicity, 2 – 5 and improved prevention and treatment strategies have decreased the severity of acute GVHD. 6 – 9 The control of infectious complications has improved since the development of molecular methods for the detection of viral and fungal infections, the use of preemptive treatments, the introduction of new antifungal agents, and the prevention of nosocomial infection. 10 – 13 To examine the hypothesis that changes in the care of . . .