Annals of Hematology

, Volume 84, Issue 1, pp 47–55 | Cite as

Quality-adjusted survival analysis shows differences in outcome after immunosuppression or bone marrow transplantation in aplastic anemia

  • Romaine Viollier
  • Jakob Passweg
  • Michael Gregor
  • Geneviève Favre
  • Thomas Kühne
  • Catherine Nissen
  • Alois Gratwohl
  • André Tichelli
Original Article

Abstract

Bone marrow transplantation (BMT) and immunosuppression (IS) have improved the prognosis of aplastic anemia; both treatments have specific advantages and drawbacks but similar survival rates. Analysis of additional endpoints may help in treatment decisions. In a single-center study, patients with aplastic anemia treated with IS (n=155) or BMT (n=52) were compared for survival, event-free survival, and quality-adjusted time without symptoms and toxicity (Q-TWiST). Probability of overall and event-free survival at 15 years was similar among both groups (BMT 51±15% and 25±14%, IS 53±10% and 27±8%), with more early deaths in the transplant group and more late deaths in the IS group. There were differences in terms of mean duration of seven analyzed health states: time with symptoms from treatment-related toxicity (IS 0.36 years, BMT 0.27), transfusion dependency (IS 0.66 years, BMT 0.1 years), partial remission (IS 3.27 years, BMT 1.42), and secondary clonal disorder (IS 0.68 years, BMT 0.04) was significantly longer for IS compared to BMT (p≤0.001). Patients treated with BMT spent more time with extensive chronic graft-versus-host disease (GvHD) (IS 0 years, BMT 0.96, p<0.023) and in CR without drugs (IS 1.22 years, BMT 2.43, p=0.056). In conclusion, survival, event-free survival, and Q-TWiST are similar. BMT-treated patients had longer periods free from symptoms, while IS-treated patients needed closer medical care, transfusion support, and medications.

Keywords

Aplastic anemia Treatment decisions Quality of life 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Romaine Viollier
    • 1
  • Jakob Passweg
    • 1
  • Michael Gregor
    • 2
  • Geneviève Favre
    • 1
  • Thomas Kühne
    • 3
  • Catherine Nissen
    • 1
  • Alois Gratwohl
    • 1
  • André Tichelli
    • 1
  1. 1.Transplantation UnitUniversity Hospitals of BaselBaselSwitzerland
  2. 2.Hämato-OnkologieKantonsspital LuzernLuzernSwitzerland
  3. 3.Universitätskinderspital beider BaselBaselSwitzerland

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