TY - JOUR AU - Matthias Eefting, AU - Liesbeth C. de Wreede, AU - Constantijn J.M. Halkes, AU - Peter A. von dem Borne, AU - Sabina Kersting, AU - Erik W.A. Marijt, AU - Hendrik Veelken, AU - Hein Putter, AU - Johannes Schetelig, AU - J.H. Frederik Falkenburg, PY - 2016/03/31 Y2 - 2024/03/29 TI - Multi-state analysis illustrates treatment success after stem cell transplantation for acute myeloid leukemia followed by donor lymphocyte infusion JF - Haematologica JA - haematol VL - 101 IS - 4 SE - Articles DO - 10.3324/haematol.2015.136846 UR - https://haematologica.org/article/view/7687 SP - 506-514 AB - In the field of hematopoietic stem cell transplantation, the common approach is to focus outcome analyses on time to relapse and death, without assessing the impact of post-transplant interventions. We investigated whether a multi-state model would give insight into the events after transplantation in a cohort of patients who were transplanted using a strategy including scheduled donor lymphocyte infusions. Seventy-eight consecutive patients who underwent myeloablative T-cell depleted allogeneic stem cell transplantation for acute myeloid leukemia or myelodysplastic syndrome were studied. We constructed a multi-state model to analyze the impact of donor lymphocyte infusion and graft-versus-host disease on the probabilities of relapse and non-relapse mortality over time. Based on this model we introduced a new measure for outcome after transplantation which we called ‘treatment success’: being alive without relapse and immunosuppression for graft-versus-host disease. All relevant clinical events were implemented into the multi-state model and were denoted treatment success or failure (either transient or permanent). Both relapse and non-relapse mortality were causes of failure of comparable magnitude. Whereas relapse was the dominant cause of failure from the transplantation state, its rate was reduced after graft-versus-host disease, and especially after donor lymphocyte infusion. The long-term probability of treatment success was approximately 40%. This probability was increased after donor lymphocyte infusion. Our multi-state model helps to interpret the impact of post-transplantation interventions and clinical events on failure and treatment success, thus extracting more information from observational data. ER -