{"doi":"10.7326/m19-2936","title":"Survival, Nonrelapse Mortality, and Relapse-Related Mortality After Allogeneic Hematopoietic Cell Transplantation: Comparing 2003–2007 Versus 2013–2017 Cohorts","abstract":"Background: Allogeneic hematopoietic cell transplantation is indicated for refractory hematologic cancer and some nonmalignant disorders. Survival is limited by recurrent cancer and organ toxicity. Objective: To determine whether survival has improved over the past decade and note impediments to better outcomes. Design: The authors compared cohorts that had transplants during 2003 to 2007 versus 2013 to 2017. Survival outcome measures were analyzed, along with transplant-related complications. Setting: A center performing allogeneic transplant procedures. Participants: All recipients of a first allogeneic transplant during 2003 to 2007 and 2013 to 2017. Intervention: Patients received a conditioning regimen, infusion of donor hematopoietic cells, then immunosuppressive drugs and antimicrobial approaches to infection control. Measurements: Day-200 nonrelapse mortality (NRM), recurrence or progression of cancer, relapse-related mortality, and overall mortality, adjusted for comorbidity scores, source of donor cells, donor type, patient age, disease severity, conditioning regimen, patient and donor sex, and cytomegalovirus serostatus. Results: During the 2003-to-2007 and 2013-to-2017 periods, 1148 and 1131 patients, respectively, received their first transplant. Over the decade, decreases were seen in the adjusted hazards of day-200 NRM (hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.89]), relapse of cancer (HR, 0.76 [CI, 0.61 to 0.94]), relapse-related mortality (HR, 0.69 [CI, 0.54 to 0.87]), and overall mortality (HR, 0.66 [CI, 0.56 to 0.78]). The degree of reduction in overall mortality was similar for patients who received myeloablative versus reduced-intensity conditioning, as well as for patients whose allograft came from a matched sibling versus an unrelated donor. Reductions were also seen in the frequency of jaundice, renal insufficiency, mechanical ventilation, high-level cytomegalovirus viremia, gram-negative bacteremia, invasive mold infection, acute and chronic graft-versus-host disease, and prednisone exposure. Limitation: Cohort studies cannot determine causality, and current disease severity criteria were not available for patients in the 2003-to-2007 cohort. Conclusion: Improvement in survival and reduction in complications were substantial after allogeneic transplant. Relapse of cancer remains the largest obstacle to better survival outcomes. Primary Funding Source: National Institutes of Health.","journal":"Annals of Internal Medicine","year":2020,"id":49234,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":278,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8982,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":236728,"name":"Brenda M. Sandmaier","orcid":"0000-0002-9767-9739","position":1,"is_corresponding":false},{"id":236729,"name":"Marco Mielcarek","orcid":"0000-0002-5680-8688","position":2,"is_corresponding":false},{"id":236730,"name":"Mohamed L. Sorror","orcid":"0000-0001-5260-1981","position":3,"is_corresponding":false},{"id":236731,"name":"Steven A. Pergam","orcid":"0000-0002-6333-5196","position":4,"is_corresponding":false},{"id":236732,"name":"Guang‐Shing Cheng","orcid":"0000-0003-4324-9634","position":5,"is_corresponding":false},{"id":236733,"name":"Sangeeta Hingorani","orcid":"0000-0003-3743-1325","position":6,"is_corresponding":false},{"id":233082,"name":"Michael Boeckh","orcid":"0000-0003-1538-7984","position":7,"is_corresponding":false},{"id":238979,"name":"Mary D. Flowers","orcid":null,"position":8,"is_corresponding":false},{"id":83997,"name":"Stephanie J. Lee","orcid":"0000-0003-2600-6390","position":9,"is_corresponding":false},{"id":3639,"name":"Frederick R. Appelbaum","orcid":"0000-0002-1839-5069","position":10,"is_corresponding":false},{"id":236734,"name":"Rainer Storb","orcid":"0000-0002-9343-4099","position":11,"is_corresponding":false},{"id":236735,"name":"Paul J. Martin","orcid":"0000-0001-9051-1215","position":12,"is_corresponding":false},{"id":56441,"name":"H. Joachim Deeg","orcid":"0000-0002-4426-9023","position":13,"is_corresponding":false},{"id":236736,"name":"Gary Schoch","orcid":"0000-0001-8933-8195","position":14,"is_corresponding":false},{"id":236737,"name":"Ted Gooley","orcid":"0000-0002-8182-3652","position":15,"is_corresponding":false},{"id":236727,"name":"George B. McDonald","orcid":"0000-0003-0581-2561","position":0,"is_corresponding":true}],"reference_count":33,"raw_metadata":null,"created_at":"2026-07-18T20:36:25.163232Z","pmid":"31958813","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}