Independent predictors for transplant-related outcomes among patients with hematologic malignancies undergoing double cord transplantation
| Transplant predictors* . | Multivariate HR (95% CI) . | |||||
|---|---|---|---|---|---|---|
| OS† . | Neutrophil recovery‡ . | TRM§ . | Relapse/ Progression|| . | aGHVD¶ . | cGHVD# . | |
| TNCs, cryopreserved | ||||||
| ≤3.5 vs >3.5 × 107/kg** | 1.53 (1.16-2.03) P = .01 | 0.65 (0.5-0.85) P = .01 | 1.57 (1.07-2.31) P = .02 | 0.97 (0.63-1.47) P = .87 | 1.08 (0.76-1.55) P = .66 | 0.85 (0.53-1.36) P = .49 |
| Total CD34+cells, cryopreserved | ||||||
| ≤1.4 vs >1.4 × 105/kg** | 0.96 (0.79-1.16) P = .65 | 0.81 (0.69-0.94) P = .01 | 1.03 (0.79-1.34) P = .83 | 1.04 (0.81-1.34) P = .76 | 0.82 (0.65-1.03) P = .08 | 0.96 (0.74-1.24) P = .76 |
| HLA mismatches | ||||||
| ≥2 vs 0-1 | 1.28 (1.06-1.56) P = .01 | 1.02 (0.88-1.16) P = .89 | 1.35 (1.04-1.77) P = .03 | 0.90 (0.71-1.14) P = .39 | 1.26 (1.02-1.57) P = .03 | 0.79 (0.63-0.99) P = .04†† |
| ABO compatibility | ||||||
| Minor or major incompatibility vs compatible | 1.28 (1.02-1.62) P = .04 | 1.02 (0.86-1.21) P = .81 | 1.34 (0.96-1.86) P = .09 | 1.03 (0.77-1.37) P = .86 | 1.04 (0.82-1.31) P = .76 | 0.91 (0.71-0.20) P = .53 |
| Transplant predictors* . | Multivariate HR (95% CI) . | |||||
|---|---|---|---|---|---|---|
| OS† . | Neutrophil recovery‡ . | TRM§ . | Relapse/ Progression|| . | aGHVD¶ . | cGHVD# . | |
| TNCs, cryopreserved | ||||||
| ≤3.5 vs >3.5 × 107/kg** | 1.53 (1.16-2.03) P = .01 | 0.65 (0.5-0.85) P = .01 | 1.57 (1.07-2.31) P = .02 | 0.97 (0.63-1.47) P = .87 | 1.08 (0.76-1.55) P = .66 | 0.85 (0.53-1.36) P = .49 |
| Total CD34+cells, cryopreserved | ||||||
| ≤1.4 vs >1.4 × 105/kg** | 0.96 (0.79-1.16) P = .65 | 0.81 (0.69-0.94) P = .01 | 1.03 (0.79-1.34) P = .83 | 1.04 (0.81-1.34) P = .76 | 0.82 (0.65-1.03) P = .08 | 0.96 (0.74-1.24) P = .76 |
| HLA mismatches | ||||||
| ≥2 vs 0-1 | 1.28 (1.06-1.56) P = .01 | 1.02 (0.88-1.16) P = .89 | 1.35 (1.04-1.77) P = .03 | 0.90 (0.71-1.14) P = .39 | 1.26 (1.02-1.57) P = .03 | 0.79 (0.63-0.99) P = .04†† |
| ABO compatibility | ||||||
| Minor or major incompatibility vs compatible | 1.28 (1.02-1.62) P = .04 | 1.02 (0.86-1.21) P = .81 | 1.34 (0.96-1.86) P = .09 | 1.03 (0.77-1.37) P = .86 | 1.04 (0.82-1.31) P = .76 | 0.91 (0.71-0.20) P = .53 |
Bold P values denote statistical significance (P < .05).
aGVHD, acute GVHD; cGVHD, chronic GVHD; CI, confidence interval; HR, hazard ratio; OS, overall survival.
Other predictor variables according to outcomes:
OS: Adjusted for age, disease status, ATG use, and year of transplant (n = 949): risks were higher in patients older than 43 years (HR, 1.29; 95% CI 1.09-1.54; P = .01); intermediate-risk (HR, 1.30; 95% CI, 1.04-1.61; P = .02) and high-risk (HR, 1.5; 95% CI, 1.22-1.87; P < .001) disease; and with use of ATG in the conditioning regimen (HR, 1.74; 95% CI, 1.45-2.10; P = <.001). Risks were lower in transplants performed after 2012 (HR, 0.80; 95% CI, 0.65-0.98; P = .03).
Neutrophil recovery: Adjusted for sex and disease risk at transplant (n = 1109): neutrophil recovery was higher in women (1.17; 95% CI, 1.03-1.33; P = .02); intermediate-risk (HR, 1.21; 95% CI, 1.05-1.42; P = .01) compared with low-risk disease.
TRM: Adjusted for age, disease risk, TBI-based conditioning, and ATG use (n = 949). Risks of TRM were higher in patients older than 39 years of age (>39 and <56 years old: HR, 1.37; 95% CI, 1.02-1.84; P = .04; ≥56 years old: HR, 1.89; 95% CI, 1.40-2.55; P < .001); intermediate-risk (HR, 1.47; 95% CI, 1.10-1.98; P = .01) and high-risk (HR, 1.45; 95% CI, 1.07-1.95; P = .02) disease; high-dose TBI (≥8 Gy) compared with those without TBI (1.51; 95% CI, 1.03-2.21; P = .04); and ATG use (HR, 1.39; 95% CI, 1.04-1.85; P = .03).
Relapse/progression: Adjusted for TBI-based conditioning regimen, disease risk, and year of transplantation (n = 1105): risks were lower in patients receiving high-dose TBI (≥8 Gy) compared with those without TBI (HR, 0.57; 95% CI, 0.38-0.85; P = .01); and in transplants performed after 2012 (HR, 0.65; 0.49-0.87; P = .01).
aGVHD: Adjusted for TBI-based conditioning regimen (n = 1165). Risks were higher in patients receiving high-dose TBI (≥8 Gy; HR, 1.83; 95% CI, 1.35-2.47; P < .001).
cGVHD: Adjusted for UCB-recipient sex match and TBI-based conditioning regimen (n = 1167): risks were higher for patients receiving TBI-based conditioning (<8 Gy [HR, 1.53; 95% CI, 1.11-2.11; P = .01]; ≥8 Gy [HR, 1.85; 95% CI, 1.29-2.65; P < .001]). Risks were lower in patients with UCB-recipient sex mismatch (HR, 0.68; 95% CI, 0.54-0.84; P < .001).
Defined by the Contal-O’Quigley method for OS (see "Methods").
Landmark analysis at day +120 did not confirm this association (GVHD, see "Results").