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  • br Methods br Discussion We observed a significantly lower

    2019-04-26


    Methods
    Discussion We observed a significantly lower than expected Day +100 TRM. Other NMAT studies [4,5] have shown similar findings, although 60% of our trial Epinephrine Bitartrate manufacturer had high risk disease per the CIBMTR classification. In this and other studies, late TRM and disease progression remains problematic and offsets the reduction in early TRM [6]. Outcomes of other NMAT studies may have been related to type of disease [7] and disease burden [8] at the time of transplant, however, our results in high-risk, advanced disease patients are comparable to McClune et al. [9]. We demonstrate that durable disease control can be achieved in 15% of patients who are not in remission pre-NMAT, with a 3-year OS of 34% in patients with relapsed disease vs. 0% in primary induction failure patients. One retrospective analysis of MDS and AML patients found that non-relapse mortality, 3-year OS and PFS did not vary between MAT and NMAT [10]. Two studies have documented a stronger Graft-versus-Leukemia (GvL) effect for those in remission vs. active disease pre-NMAT [10,11]. A randomized multi-center trial is currently accruing patients to compare MAT vs. NMAT regimens in AML and MDS patients [12]. In our study, lower KPS was a significant risk factor for shorter OS that is comparable to 2 other studies [13,14]. This factor could be studied further as a prospective, prognostic indicator of survival along with the HCT co-morbidity index [15]. A major cause of morbidity and mortality following NMAT is infection, in both our study and others [16,17]. Despite a decrease in early bacterial infection due to a shorter time to neutrophil recovery and less mucosal damage, there is an increased risk for later viral and fungal infections [17,18]. Our study confirms another [16] that CMV serologic status is associated with OS and needs to be considered in the donor selection process. The development of NMAT has changed the application of allogeneic transplantation. The curative effect of NMAT is dependent on donor cell-mediated immunotherapy [19–21]. The reduction of early TRM must be balanced with PFS and late TRM. FluCy Epinephrine Bitartrate manufacturer has a low rate of early TRM and is curative in approximately 20% of advanced disease patients. Identification of pre-NMAT factors which predict for long-term survival may allow more appropriate patient selection for FluCy versus alternative NMAT regimens and newer reduced toxicity regimens.
    Acknowledgments This work is supported by the Graduate Scholarship in Cancer Nursing Practice from the American Cancer Society (Grant no. GSCNP-10-218-01-SCN).