A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor
| Autor: | Satoshi Takahashi, Satoshi Morita, Jin Takeuchi, Yasushi Miyazaki, Hisashi Sakamaki, Shinichi Kako, Itsuro Jinnai, Taiichi Kyo, Toru Sakura, K Iwato, Tomoki Naoe, M Onizuka, Tetsuya Fukuda, Hiroyasu Ogawa, Heiwa Kanamori, Ritsuro Suzuki, Yoshinobu Kanda, Kazunori Ohnishi, S Miyawaki, Yoshiko Atsuta |
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| Rok vydání: | 2010 |
| Předmět: |
Oncology
Adult Male Cancer Research medicine.medical_specialty Adolescent Databases Factual medicine.medical_treatment Population Hematopoietic stem cell transplantation Philadelphia chromosome Risk Assessment Decision Support Techniques Leukocyte Count Young Adult HLA Antigens Acute lymphocytic leukemia Internal medicine medicine Humans Transplantation Homologous Philadelphia Chromosome education Survival rate Probability education.field_of_study business.industry Siblings Remission Induction Age Factors Hematopoietic Stem Cell Transplantation Hematology Middle Aged Precursor Cell Lymphoblastic Leukemia-Lymphoma medicine.disease Histocompatibility Transplantation Survival Rate Leukemia Immunology Cytogenetic Analysis Quality of Life Female business |
| Zdroj: | Leukemia. 25(2) |
| ISSN: | 1476-5551 |
| Popis: | Clinical studies using genetic randomization cannot accurately answer whether adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL) who have a human leukocyte antigen (HLA)-matched sibling should undergo allogeneic hematopoietic stem cell transplantation (HSCT) or chemotherapy in first remission, as, in these studies, patients without a sibling donor undergo alternative donor transplantation or chemotherapy alone after a relapse. Therefore, we performed a decision analysis to identify the optimal strategy in this setting. Transition probabilities and utilities were estimated from prospective studies of the Japan Adult Leukemia Study Group, the database of the Japan Society for Hematopoietic Cell Transplantation and the literature. The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustments. Subgroup analyses were performed according to risk stratification on the basis of white blood cell count and cytogenetics, and according to age stratification. In analyses without QOL adjustments, allogeneic HSCT in first remission was superior in the whole population (48.3 vs 32.6%) and in all subgroups. With QOL adjustments, a similar tendency was conserved (44.9 vs 31.7% in the whole population). To improve the probability of long-term survival, allogeneic HSCT in first remission is recommended for patients who have an HLA-matched sibling. |
| Databáze: | OpenAIRE |
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