Decision Analysis for Unrelated Bone Marrow Transplantation or Immediate Cord Blood Transplantation for Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia in First Complete Remission
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Le résumé fourni par la source
An HLA-matched relative is the first-choice donor for patients with Philadelphia chromosome (Ph)-negative acute lymphoblastic leukemia (ALL) in first complete remission (CR1). The most promising alternative donor is thought to be an HLA-matched unrelated donor (MUD) in patients who do not have an HLA-matched related donor. Cord blood transplantation (CBT) is an alternative option. Higher rates of engraftment failure and nonrelapse mortality (NRM) are significant problems, but the ready availability of cord blood can be an advantage, because patients can immediately undergo transplantation before progression. This study was conducted to identify an appropriate alternative donor in patients with Ph-negative ALL in CR1 who do not have an HLA-matched related donor (MRD). Decision analyses using a Markov model were performed to compare immediate CBT, in which CBT was performed at 1 month after the achievement of CR1, with elective unrelated bone marrow transplantation (uBMT) from an 8/8 MUD (8/8 uBMT) or uBMT from a 7/8 MUD (7/8 uBMT), in which uBMT was performed at 4 months, in patients age 16 to 55 years with Ph-negative ALL in CR1 who did not have an MRD. We constructed a decision tree. The cycle length was set at 3 months, and analyses were performed for 19 cycles for uBMT and 20 cycles for CBT, resulting in evaluation of the 5-year life expectancy after both decisions. Transition probabilities (TPs) and utilities were estimated from prospective and retrospective Japanese studies and the registry database of Japan. Subgroup analyses were performed according to risk stratification based on WBC count and cytogenetics at diagnosis and according to age stratification, with a cutoff of 25 years. One-way sensitivity analyses for TPs and utilities were performed as well. The baseline analyses showed that 8/8 uBMT or 7/8 uBMT had superior results to CBT, with quality-adjusted life years (QALYs) of 2.86 in 8/8 uBMT, 2.84 in 7/8 uBMT, and 2.75 in CBT. One-way sensitivity analyses showed that the results of the baseline analyses were reversed if the probability of NRM in CBT improved. Subgroup analyses showed similar results in younger, older, and high-risk patients. However, QALY was worse in 8/8 uBMT compared with CBT in standard-risk patients. In one-way sensitivity analyses, the probabilities of NRM in uBMT and CBT affected the baseline results in all analyses except for comparisons between 8/8 uBMT and CBT in younger and high-risk patients. In these 2 populations, the superiority of 8/8 uBMT was consistently demonstrated throughout the one-way sensitivity analyses. For patients with Ph-negative ALL in CR1 who decide to undergo transplantation from an alternative donor, elective uBMT from either an 8/8 MUD or a 7/8 MUD is expected to yield a better outcome than immediate CBT. Nonetheless, CBT is a viable option, and improvements to reduce the risk of NRM in CBT may change these results.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Decision Analysis for Unrelated Bone Marrow Transplantation or Immediate Cord Blood Transplantation for Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia in First Complete Remission
- Date Crossref
- 01/03/2022
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Jichi Medical University Division of Hematology pays non établi dans la noticeUniversité ou école supérieure
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Jichi Medical University Saitama Medical Center pays non établi dans la noticeÉtablissement de santé
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Nagoya University Department of Cellular and Genetic Sciences pays non établi dans la noticeUniversité ou école supérieure
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Tokyo Women's Medical University Department of Hematology pays non établi dans la noticeUniversité ou école supérieure
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Otaru Municipal Hospital pays non établi dans la noticeÉtablissement de santé
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Kyoto University pays non établi dans la noticeUniversité ou école supérieure
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University of the Ryukyus pays non établi dans la noticeUniversité ou école supérieure
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Toranomon Hospital Department of Hematology pays non établi dans la noticeÉtablissement de santé
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Federation of National Public Service Personnel Mutual Aid Associations pays non établi dans la noticeOrganisation à but non lucratif
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Tokyo Metropolitan Komagome Hospital Tokyo Metropolitan Cancer and Infectious Diseases Center pays non établi dans la noticeÉtablissement de santé
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Hyogo Medical University pays non établi dans la noticeUniversité ou école supérieure
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Gunma Saiseikai Maebashi Hospital pays non établi dans la noticeÉtablissement de santé
Division of Hematology — Jichi Medical University, Jichi Medical University Saitama Medical Center et Department of Cellular and Genetic Sciences — Nagoya University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.