Informace o publikaci

Explaining survival differences between two consecutive studies with allogeneic stem cell transplantation in patients with chronic myeloid leukemia

Autoři	PFIRRMANN Markus SAUSSELE Susanne HOCHHAUS Andreas REITER Andreas BERGER Ute HOSSFELD Dieter K. NERL Christoph SCHEID Christof SPIEKERMANN Karsten MAYER Jiří HELLMANN Andrzej LECHNER Klaus FALGE Christiane SAYER Herbert G, BUNJES Donald GANSER Arnold BEELEN Dietrich W. BALDOMERO Helen SCHANZ Urs HEIMPEL Hermann KOLB Hans-Jochem HASFORD Joerg GRATWOHL Alois HEHLMANN Rüdiger
Rok publikování	2014
Druh	Článek v odborném periodiku
Časopis / Zdroj	Journal of cancer research and clinical oncology
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
Doi	http://dx.doi.org/10.1007/s00432-014-1662-y
Obor	Onkologie a hematologie
Klíčová slova	Chronic myeloid leukemia; Allogeneic stem cell transplantation; Post-transplant overall survival; Cox cure model; Prognostic factors
Popis	Purpose In the two consecutive German studies III and IIIA on chronic myeloid leukemia, between 1995 and 2004, 781 patients were randomized to receive either allogeneic hematopoietic stem cell transplantation with a related donor or continued drug treatment. Despite comparable transplantation protocols and most centers participating in both studies, the post-transplant survival probabilities for patients transplanted in first chronic phase were significantly higher in study IIIA (144 patients) than in study III (113 patients). Prior to the decision on a combined analysis of both studies, reasons for this discrepancy had to be investigated. Methods The Cox proportional hazard cure model was used to identify prognostic factors for post-transplant survival. Results Donor-recipient matching for human leukocyte antigen, patient age, time between diagnosis and transplantation, and calendar time showed a significant influence on survival and/or the incidence of cure. Added as a further factor, affiliation to study IIIA had no significant impact any longer. Conclusions Discrepancies in influential prognostic factors explained the different post-transplant survival probabilities between the studies. The significance of calendar time suggests a lack of consistency of transplantation practice over time. Accordingly, the prerequisite for a common assessment of overall survival in the two randomized transplantation arms was not met. Moreover, our analyses provide an independent validation of established prognostic factors and their cutoffs. The statistical approach in investigating and modeling potential prognostic factors for survival sets an example for the examination of studies with unexpected outcome differences in concurrent treatment arms.