Machine learning evaluation of intensified conditioning on haematopoietic stem cell transplantation in adult acute lymphoblastic leukemia patients.

Autor: Jo T; Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. tjoh@kuhp.kyoto-u.ac.jp.; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan. tjoh@kuhp.kyoto-u.ac.jp.; Department of Cytotherapy, Kyoto University Hospital, Kyoto, Japan. tjoh@kuhp.kyoto-u.ac.jp., Inoue K; Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.; Hakubi Center for Advanced Research, Kyoto University, Kyoto, Japan., Ueda T; Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Suita, Japan., Iwasaki M; Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan., Akahoshi Y; Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan., Nishiwaki S; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan., Hatsusawa H; Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan., Nishida T; Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan., Uchida N; Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan., Ito A; Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan., Tanaka M; Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan., Takada S; Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan., Kawakita T; Department of Hematology, NHO Kumamoto Medical Center, Kumamoto, Japan., Ota S; Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan., Katayama Y; Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan., Takahashi S; Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan., Onizuka M; Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan., Hasegawa Y; Department of Hematology, Hokkaido University Hospital, Sapporo, Japan., Kataoka K; Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan., Kanda Y; Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.; Division of Hematology, Jichi Medical University, Tochigi, Japan., Fukuda T; Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan., Tabuchi K; Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan., Atsuta Y; Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan.; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan., Arai Y; Department of Hematology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. ysykrai@kuhp.kyoto-u.ac.jp.; Center for Research and Application of Cellular Therapy, Kyoto University Hospital, Kyoto, Japan. ysykrai@kuhp.kyoto-u.ac.jp.; Department of Cytotherapy, Kyoto University Hospital, Kyoto, Japan. ysykrai@kuhp.kyoto-u.ac.jp.
Jazyk: angličtina
Zdroj: Communications medicine [Commun Med (Lond)] 2024 Nov 25; Vol. 4 (1), pp. 247. Date of Electronic Publication: 2024 Nov 25.
DOI: 10.1038/s43856-024-00680-y
Abstrakt: Background: The advantage of intensified myeloablative conditioning (MAC) over standard MAC has not been determined in haematopoietic stem cell transplantation (HSCT) for adult acute lymphoblastic leukemia (ALL) patients.
Methods: To evaluate heterogeneous effects of intensified MAC among individuals, we analyzed the registry database of adult ALL patients between 2000 and 2021. After propensity score matching, we applied a machine-learning Bayesian causal forest algorithm to develop a prediction model of individualized treatment effect (ITE) of intensified MAC on reduction in overall mortality at 1 year after HSCT.
Results: Among 2440 propensity score-matched patients, our model shows heterogeneity in the association between intensified MAC and 1-year overall mortality. Individuals in the high-benefit group (n = 1220), defined as those with ITEs greater than the median, are more likely to be younger, male, and to have higher refined Disease Risk Index (rDRI), T-cell phenotype, and grafts from related donors than those in the low-benefit group (n = 1220). The high-benefit approach (applying intensified MAC to individuals in the high-benefit group) shows the largest reduction in overall mortality at 1 year (risk difference [95% confidence interval], +5.94 percentage points [0.88 to 10.51], p = 0.011). In contrast, the high-risk approach (targeting patients with high or very high rDRI) does not achieve statistical significance (risk difference [95% confidence interval], +3.85 percentage points [-1.11 to 7.90], p = 0.063).
Conclusions: These findings suggest that the high-benefit approach, targeting patients expected to benefit from intensified MAC, has the capacity to maximize HSCT effectiveness using intensified MAC.
Competing Interests: Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: