Impact of Pretransplantation Renal Dysfunction on Outcomes after Allogeneic Hematopoietic Cell Transplantation

被引:15
作者
Farhadfar, Nosha [1 ]
Dias, Ajoy [2 ]
Wang, Tao [3 ,4 ]
Fretham, Caitrin [5 ]
Chhabra, Saurabh [3 ,6 ]
Murthy, Hemant S. [7 ]
Broglie, Larisa [3 ,8 ]
D'Souza, Anita [3 ]
Gadalla, Shahinaz M. [9 ]
Gale, Robert Peter [10 ]
Hashmi, Shahrukh [11 ,12 ]
Al-Homsi, A. Samer [13 ]
Hildebrandt, Gerhard C. [14 ]
Hematti, Peiman [15 ]
Rizzieri, David [16 ]
Chee, Lynette [17 ,18 ]
Lazarus, Hillard M. [19 ]
Bredeson, Christopher [20 ,21 ]
Jaimes, Edgar A. [22 ]
Beitinjaneh, Amer [23 ]
Bashey, Asad [24 ]
Prestidge, Tim [25 ]
Krem, Maxwell M. [26 ]
Marks, David, I [27 ]
Benoit, Stefanie [28 ,29 ]
Yared, Jean A. [30 ]
Nishihori, Taiga [31 ]
Olsson, Richard F. [32 ,33 ]
Freytes, Cesar O. [34 ]
Stadtmauer, Edward [35 ]
Savani, Bipin N. [36 ]
Sorror, Mohamed L. [37 ,38 ]
Ganguly, Siddhartha [39 ]
Wingard, John R. [40 ]
Pasquini, Marcelo [3 ]
机构
[1] Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA
[2] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[3] Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
[4] Med Coll Wisconsin, Inst Hlth & Equ, Div Biostat, Milwaukee, WI 53226 USA
[5] Natl Marrow Donor Program Be Match, CIBMTR Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA
[6] Med Coll Wisconsin, Dept Med, Div Hematol Oncol, Milwaukee, WI 53226 USA
[7] Mayo Clin, Div Hematol Oncol, Blood & Marrow Transplantat Program, Jacksonville, FL USA
[8] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA
[9] NCI, Div Canc Epidemiol & Genet, NIH, Clin Genet Branch, Rockville, MD USA
[10] Imperial Coll London, Haematol Res Ctr, Dept Immunol & Inflammat, London, England
[11] Mayo Clin, Dept Internal Med, Rochester, MN USA
[12] Sheikh Shakhbout Med City, Dept Med, Abu Dhabi, U Arab Emirates
[13] New York Univ Langone Hlth, New York, NY USA
[14] Univ Kentucky, Markey Canc Ctr, Lexington, KY USA
[15] Univ Wisconsin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI USA
[16] Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA
[17] Royal Melbourne Hosp City Campus, Parkville, Vic, Australia
[18] Peter MacCallum Canc Ctr, Parkville, Vic, Australia
[19] Case Western Reserve Univ, Univ Hosp Cleveland Med Ctr, Cleveland, OH 44106 USA
[20] Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada
[21] Ottawa Hosp Res Inst, Ottawa, ON, Canada
[22] Mem Sloan Kettering Canc Ctr, Renal Serv, 1275 York Ave, New York, NY 10021 USA
[23] Univ Miami, Div Transplantat & Cellular Therapy, Miami, FL USA
[24] Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA
[25] Starship Childrens Hosp, Blood & Canc Ctr, Auckland, New Zealand
[26] Univ Kentucky, Coll Med, Markey Canc Ctr, Lexington, KY USA
[27] Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England
[28] Cincinnati Childrens Hosp Med Ctr, Div Nephrol & Hypertens, Cincinnati, OH 45229 USA
[29] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH USA
[30] Univ Maryland, Dept Med, Greenebaum Comprehens Canc Ctr, Blood & Marrow Transplantat Program,Div Hematol O, Baltimore, MD 21201 USA
[31] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunot, Tampa, FL USA
[32] Karolinska Inst, Dept Lab Med, Stockholm, Sweden
[33] Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
[34] Texas Transplant Inst, San Antonio, TX USA
[35] Univ Penn, Med Ctr, Abramson Canc Ctr, Philadelphia, PA 19104 USA
[36] Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA
[37] Fred Hutchinson Canc Res Ctr, Clin Res Div, Washington, DC USA
[38] Univ Washington, Sch Med, Dept Med, Div Med Oncol, Seattle, WA 98195 USA
[39] Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA
[40] Univ Florida, Dept Med, Div Hematol & Oncol, Gainesville, FL USA
来源
TRANSPLANTATION AND CELLULAR THERAPY | 2021年 / 27卷 / 05期
关键词
Renal dysfunction; HCT-CI; Allogeneic transplantation; Dialysis; CHRONIC KIDNEY-DISEASE; POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; COMORBIDITY INDEX; GRAFT; CALCINEURIN; FERRITIN; FAILURE; ALBUMIN; PATIENT;
D O I
10.1016/j.jtct.2021.02.030
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Renal dysfunction is a recognized risk factor for mortality after allogeneic hematopoietic cell transplantation (alloHCT), yet our understanding of the effect of different levels of renal dysfunction at time of transplantation on outcomes remains limited. This study explores the impact of different degrees of renal dysfunction on HCT outcomes and examines whether the utilization of incremental degrees of renal dysfunction based on estimated glomerular filtration rate (eGFR) improve the predictability of the hematopoietic cell transplantation comorbidity index (HCT-CI). The study population included 2 cohorts: cohort 1, comprising patients age >= 40 years who under went alloHCT for treatment of hematologic malignancies between 2008 and 2016 (n = 13,505; cohort selected given a very low incidence of renal dysfunction in individuals age <40 years), and cohort 2, comprising patients on dialysis at the time of HCT (n = 46). eGFR was measured using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) method. The patients in cohort 1 were assigned into 4 categories-eGFR >= 90 mL/min (n = 7062), eGFR 60 to 89 mL/min (n = 5264), eGFR 45 to 59 mL/min (n = 897), and eGFR <45 mL/min (n=282)-to assess the impact of degree of renal dysfunction on transplantation outcomes. Transplantation outcomes in patients on dialysis at the time of alloHCT were analyzed separately. eGFR <60 mL/min was associated with an increased risk for nonrelapse mortality (NRM) and requirement for dialysis post-HCT. Compared with the eGFR >= 90 group, the hazard ratio (HR) for NRM was 1.46 (P = .0001) for the eGFR 45 to 59 mL/min group and 1.74 (P = .004) for the eGFR <45 mL/min group. Compared with the eGFR >= 90 mL/min group, the eGFR 45 to 59 mL/min group (HR, 2.45; P < .0001) and the eGFR <45 mL/min group (HR, 3.09; P < .0001) had a higher risk of renal failure necessitating dialysis after alloHCT. In addition, eGFR <45 mL/min was associated with an increased overall mortality (HR, 1.63; P < .0001). An eGFR-based revised HCT-CI was also developed and shown to be predictive of overall survival (OS) and NRM, with predictive performance similar to the original HCT-CI. Among 46 patients on dialysis at alloHCT, the 1-year probability of OS was 20%, and that of NRM was 67%. The degree of pretransplantation renal dysfunction is an independent predictor of OS, NRM, and probability of needing dialysis after alloHCT. An eGFR-based HCT-CI is a validated index for predicting outcomes in adults with hematologic malignancies undergoing alloHCT. The outcomes of alloHCT recipients on dialysis are dismal; therefore, one should strongly weigh the significant risks of being on hemodialysis as a factor in determining alloHCT candidacy. (C) 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:410 / 422
页数:13
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