Chronic kidney disease, survival and graft-versus-host-disease-free/relapse-free survival in recipients of allogeneic hematopoietic stem cell transplant

Background Advances in allogeneic hematopoietic stem cell transplant (HSCT) have increased patient survival, although substantial treatment-related toxicity remains, including chronic kidney disease (CKD). We assessed the association between CKD, and survival and transplant-specific outcomes in HSCT recipients. Methods We conducted a retrospective study of all 408 adult patients with allogenic HSCT at Princess Margaret Cancer Centre (Toronto, Canada, 2015-2018). We used logistic regression to identify risk factors for CKD at 1-year post-transplant. Associations between CKD at 1-year and overall survival, relapse-free survival, graft-versus-host-disease (GVHD)-free/relapse-free survival, relapse and transplant-related mortality were examined using extended time-varying Cox models. In a sensitivity analysis, we restricted the cohort to survivors at 1-year, using standard Cox proportional hazard models to examine associations between CKD and overall survival, relapse-free survival and GVHD-free/relapse-free survival, and Fine and Gray's competing risk models to determine associations between CKD and relapse/transplant-related mortality. Results The prevalence of CKD at 1-year was 19% (46 patients) with median follow-up of 23 months. Multivariable regression identified age at transplant (adjusted OR 1.09, 95%CI = 1.05-1.14, p < 0.0001), female gender (aOR 2.83, 95%CI = 1.34-5.97, p = 0.006) and acute kidney injury during the first 100 days (aOR 3.86, 95%CI = 1.70-8.73, p = 0.001) as risk factors for CKD at 1-year. Patients with CKD at 1-year had significantly poorer overall survival than those without CKD, when adjusted for relevant covariates (adjusted HR 1.93, 95%CI = 1.02-3.66, p = 0.04 in the time-varying Cox model and aHR 2.06, 95%CI = 1.04-4.07, p = 0.04 using standard Cox model). CKD at 1-year was also associated with worse GVHD-free/relapse-free survival (aHR 1.65, 95%CI = 1.04-2.61, p = 0.03). Conclusions CKD adversely affects the long-term prognosis for allogeneic HSCT recipients, with increased mortality risk and worse GVHD-free/relapse-free survival.