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Impact of Fluid Overload as New Toxicity Category on Hematopoietic Stem-cell Transplant Outcomes
- Publication Year :
- 2017
-
Abstract
- Fluid overload (FO) commonly occurs during hospitalization for allogeneic hematopoietic stem cell transplantation. We hypothesized that FO is associated with transplantation outcomes and evaluated this complication in 2 cohorts of patients. FO was graded based on post-transplantation weight gain, symptoms, and need for treatment, scored in real time by an independent team. The first cohort (study cohort; n = 145) underwent haploidentical transplantation for hematologic malignancies following a melphalan-based conditioning regimen. In univariate analysis, factors associated with day +100 nonrelapse mortality (NRM) were FO grade ≥2 (hazard ratio [HR], 15; 95% confidence interval [CI], 4.2 to 55; P .001), creatinine1 mg/dL (HR, 4.7; 95% CI, 1.6 to 14; P = .005), and age55 years (HR, 4.5; 95% CI, 1.5 to 13; P = .008). In multivariate analysis, factors associated with day +100 NRM were FO grade ≥2 (HR, 13.1; 95% CI, 3.4 to 50; P .001) and serum creatinine level1 mg/dL at transplantation admission (HR, 3.5; 95% CI, 1.1 to 11; P = .03). These findings were verified in a separate cohort (validation cohort) of patients with acute myelogenous leukemia/myelodysplastic syndrome who underwent HLA-matched transplantation with busulfan-based conditioning (n = 449). In multivariate analysis, factors associated with day +100 NRM were FO grade ≥2 (HR, 34; 95% CI, 7.2 to 158; P .001) and, in patients with FO grade2, advanced disease status (HR, 5; 95% CI, 1.1 to 22; P = .03). A higher NRM translated to significantly poorer 1-year overall survival rates for patients with FO ≥2 than for patients without FO (70% versus 42%, P .001 in the study cohort and 64% versus 38%, P .001 in the validation cohort). In conclusion, FO grade ≥2 is strongly associated with higher NRM and shorter survival and should be considered an important prognostic factor in transplantation.
- Subjects :
- Melphalan
Adult
Male
medicine.medical_specialty
Transplantation Conditioning
Adolescent
medicine.medical_treatment
Transplants
Hematopoietic stem cell transplantation
Weight Gain
Article
03 medical and health sciences
Young Adult
0302 clinical medicine
Internal medicine
medicine
Edema
Humans
Aged
Transplantation
Univariate analysis
business.industry
Hazard ratio
Hematopoietic Stem Cell Transplantation
Hematology
Middle Aged
Surgery
Body Fluids
Leukemia, Myeloid, Acute
030220 oncology & carcinogenesis
Hematologic Neoplasms
Myelodysplastic Syndromes
Cohort
Fluid Therapy
Female
Complication
business
Busulfan
030215 immunology
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....160fc8449d32d80366081fcf720b2c35