医学
生活质量(医疗保健)
共病
移植
内科学
萧条(经济学)
随机对照试验
队列
老年学
宏观经济学
护理部
经济
作者
Mohamed L. Sorror,Ted Gooley,Barry E. Storer,Aaron T. Gerds,Mikkael A. Sekeres,Bruno C. Medeiros,Eunice S. Wang,Paul J. Shami,Kehinde Adekola,Selina M. Luger,Maria R. Baer,David A. Rizzieri,Tanya M. Wildes,Jamie Koprivnikar,Julie Smith,Mitchell Garrison,Kiarash Kojouri,Tammy A. Schuler,Wendy Leisenring,Lynn Onstad,Pamela S. Becker,Stephanie J. Lee,Brenda M. Sandmaier,Frederick R. Appelbaum,Elihu H. Estey
出处
期刊:Blood
[Elsevier BV]
日期:2023-01-19
卷期号:141 (3): 295-308
被引量:4
标识
DOI:10.1182/blood.2022016916
摘要
Abstract We designed a prospective, observational study enrolling patients presenting for treatment of acute myeloid leukemia (AML) at 13 institutions to analyze associations between hematopoietic cell transplantation (HCT) and survival, quality of life (QOL), and function in: the entire cohort, those aged ≥65 years, those with high comorbidity burden, intermediate cytogenetic risk, adverse cytogenetic risk, and first complete remission with or without measurable residual disease. Patient were assessed 8 times over 2 years. Time-dependent regression models were used. Among 692 patients that were evaluable, 46% received HCT with a 2-year survival of 58%. In unadjusted models, HCT was associated with reduced risks of mortality most of the subgroups. However, after accounting for covariates associated with increased mortality (age, comorbidity burden, disease risks, frailty, impaired QOL, depression, and impaired function), the associations between HCT and longer survival disappeared in most subgroups. Although function, social life, performance status, and depressive symptoms were better for those selected for HCT, these health advantages were lost after receiving HCT. Recipients and nonrecipients of HCT similarly ranked and expected cure as main goal of therapy, whereas physicians had greater expectations for cure than the former. Accounting for health impairments negates survival benefits from HCT for AML, suggesting that the unadjusted observed benefit is mostly owing to selection of the healthier candidates. Considering patients’ overall expectations of cure but also the QOL burdens of HCT motivate the need for randomized trials to identify the best candidates for HCT. This trial was registered at www.clinicaltrials.gov as #NCT01929408.