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Competing-risk Outcomes After Hematopoietic Stem Cell Transplantation from the Perspective of Time-dependent Effects

by Daniel Fürst, Sandra Frank, Carlheinz R. Mueller, Dietrich W. Beelen, Johannes Schetelig, Dietger Niederwieser, Jürgen Finke, Donald Bunjes, Nicolaus Kröger, Christine Neuchel, Chrysanthi Tsamadou, Hubert Schrezenmeier, Jan Beyersmann, Joannis Mytilineos · 2018

ISBN:  Unavailable

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Abstract: The success of hematopoietic stem cell transplantation is determined by multiple factors. Additional complexity is conferred by covariables showing time-dependent effects. We evaluated the effect of predictors on competing-risk outcomes after hematopoietic stem cell transplantation in a time-dependent manner. We analyzed 14951 outcomes of adult patients with hematologic malignancies who underwent a first allogeneic transplant. We extended the combined endpoints of disease-free and overall survival to competing-risk settings: disease-free survival was split into relapse and non-relapse mortality. Overall survival was divided into transplant-related mortality, death from other causes and death from unknown causes. For time-dependent effects we computed estimators before and after a covariable-specific cut-point. Patients treated with reduced intensity conditioning had a constantly higher risk of relapse compared to patients treated with myeloablative conditioning. For non-relapse mortality, patients treated with reduced intensity conditioning had a reduced mortality risk but this effect was only seen in the first 4 months after transplantation (hazard ratio: 0.76, P