TY - JOUR
T1 - Impact of Fluid Overload as New Toxicity Category on Hematopoietic Stem Cell Transplantation Outcomes
AU - Rondón, Gabriela
AU - Saliba, Rima M.
AU - Chen, Julianne
AU - Ledesma, Celina
AU - Alousi, Amin M.
AU - Oran, Betul
AU - Hosing, Chitra M.
AU - Kebriaei, Partow
AU - Khouri, Issa F.
AU - Shpall, Elizabeth J.
AU - Popat, Uday R.
AU - Champlin, Richard E.
AU - Ciurea, Stefan O.
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2017/12
Y1 - 2017/12
N2 - 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), creatinine >1 mg/dL (HR, 4.7; 95% CI, 1.6 to 14; P =.005), and age >55 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 level >1 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 grade <2, 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.
AB - 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), creatinine >1 mg/dL (HR, 4.7; 95% CI, 1.6 to 14; P =.005), and age >55 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 level >1 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 grade <2, 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.
KW - Allogeneic stem cell transplantation
KW - Fluid overload
KW - Fluid retention
KW - Fluid toxicity
KW - Haploidentical transplantation
KW - Nonrelapse mortality
KW - Weight gain
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U2 - 10.1016/j.bbmt.2017.08.021
DO - 10.1016/j.bbmt.2017.08.021
M3 - Article
C2 - 28844946
AN - SCOPUS:85031114503
SN - 1083-8791
VL - 23
SP - 2166
EP - 2171
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -