Competing-risk outcomes after hematopoietic stem cell transplantation from the perspective of time-dependent effects
Daniel Fuerst,
Sandra Frank,
Carlheinz Mueller,
Dietrich W Beelen,
Johannes Schetelig,
Dietger Niederwieser,
Jürgen Finke,
Donald Bunjes,
Nicolaus Kröger,
Christine Neuchel,
Chrysanthi Tsamadou,
Hubert Schrezenmeier,
Jan Beyersmann,
Joannis Mytilineos
Affiliations
Daniel Fuerst
Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg – Hessen and University Clinic Ulm, Germany;Institute of Transfusion Medicine, University of Ulm, Germany
Sandra Frank
Institute of Statistics, University of Ulm, Germany;DRST – German Registry for Stem Cell Transplantation, Germany
Carlheinz Mueller
DRST – German Registry for Stem Cell Transplantation, Germany;Zentrales Knochenmarkspender-Register Deutschland (ZKRD - German Bone Marrow Donor Registry), Ulm, Germany
Dietrich W Beelen
DRST – German Registry for Stem Cell Transplantation, Germany;Department of Bone Marrow Transplantation, University Hospital, University of Duisburg-Essen, Essen
Johannes Schetelig
Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany
Dietger Niederwieser
Department of Hematology/Oncology, University of Leipzig, Germany
Jürgen Finke
Faculty of Medicine and Medical Center, University of Freiburg, Germany
Donald Bunjes
Department of Internal Medicine III, University of Ulm, Germany
Nicolaus Kröger
Department for Stem Cell Transplantation, University Cancer Center Hamburg, Germany
Christine Neuchel
Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg – Hessen and University Clinic Ulm, Germany;Institute of Transfusion Medicine, University of Ulm, Germany
Chrysanthi Tsamadou
Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg – Hessen and University Clinic Ulm, Germany;Institute of Transfusion Medicine, University of Ulm, Germany
Hubert Schrezenmeier
Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg – Hessen and University Clinic Ulm, Germany;Institute of Transfusion Medicine, University of Ulm, Germany
Jan Beyersmann
Institute of Statistics, University of Ulm, Germany
Joannis Mytilineos
Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg – Hessen and University Clinic Ulm, Germany;Institute of Transfusion Medicine, University of Ulm, Germany;DRST – German Registry for Stem Cell Transplantation, Germany
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
