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F Offner, G Schoch, LD Fisher, B Torok-Storb and PJ Martin
Division of Clinical Research, Fred Hutchinson Cancer Research Center,
Seattle, WA 98104, USA.
We characterized the relationship between severe neutropenia and risk of
death in 2,276 patients after marrow transplantation to define objective
and clinically relevant criteria that could be used to judge the timing and
potential value of interventions designed to improve survival in patients
with delayed initial engraftment. Proportional hazard models were used to
estimate the relative risk of death before day 100 among patients alive on
any given day with an absolute neutrophil count (ANC) less than 100/microL
compared with those alive on the same day with an ANC > or = 100/microL.
Between day 10 and 14, the risk ratio remained close to 1.0, indicating
that the risk of death before day 100 for patients with an ANC less than
100/microL was similar to that for patients with an ANC > or =
100/microL. Between day 15, when 38% of patients had an ANC less than
100/microL, and day 26, when 3.8% of patients had an ANC less than
100/microL, the risk ratio showed an overall upward trend, indicating that
patients with an ANC less than 100/microL had a higher risk of death before
day 100 than those with an ANC > or = 100/microL. Thereafter, the risk
ratio fluctuated between 2.01 and 5.78, indicating consistently higher
risks of mortality in patients with severe neutropenia. However, allogeneic
and autologous transplant recipients each had distinctive risk ratio
patterns. These results could be helpful in deciding the appropriate timing
for treatment given to improve graft function after marrow transplantation.
This article has been cited by other articles:
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| Copyright © 1996 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
