Pre-transplant diabetes mellitus is a risk factor for non-relapse mortality, especially infection-related mortality, after allogeneic hematopoietic SCT

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 4; pp. 553 - 558
• Main Authors: Takano, K, Fuji, S, Uchida, N, Ogawa, H, Ohashi, K, Eto, T, Sakamaki, H, Morishima, Y, Kato, K, Suzuki, R, Fukuda, T
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2015; Nature Publishing Group
• Subjects: 692/308; 692/699/1541/1990; Adolescent; Adult; Aged; Aged, 80 and over; Allografts; Bone marrow; Cell Biology; Child; Child, Preschool; Clinical trials; Comorbidity; Comparative analysis; Complications and side effects; Confidence intervals; Diabetes; Diabetes mellitus; Diabetes Mellitus - mortality; Disease-Free Survival; Female; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Graft-versus-host reaction; Health aspects; Health risks; Hematology; Hematopoietic Stem Cell Transplantation; Humans; Infant; Infection - etiology; Infection - mortality; Infections; Internal Medicine; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Multivariate analysis; original-article; Patient outcomes; Patients; Prophylaxis; Public Health; Recurrence (Disease); Registries; Retrospective Studies; Risk analysis; Risk factors; Stem cell transplantation; Stem Cells; Survival Rate; Tacrolimus; Transplantation; Transplantation Conditioning; Transplants & implants; Japan
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2014.315

Diabetes mellitus (DM) is a factor in the hematopoietic cell transplantation-comorbidity index. However, the impact of pre-transplant DM on morbidity and cause-specific non-relapse mortality (NRM) remains unclear. We performed a retrospective study with registry data that included a total of 7626 patients who underwent their first allogeneic hematopoietic SCT (HSCT) between 2007 and 2010. The median age was 44 years (range 0–88). Compared with patients without pre-transplant DM (non-DM group,
n
=7248), patients with pre-transplant DM (DM group,
n
=378) were older and were more likely to have high-risk disease, a reduced-intensity conditioning regimen and GVHD prophylaxis using tacrolimus. Multivariate analyses showed that pre-transplant DM was associated with increased risks of NRM (hazard ratio (HR)1.46, 95% confidence interval (CI) 1.21–1.76,
P
<0.01) and infection-related NRM (HR 2.08, 95% CI 1.58–2.73,
P
<0.01). The presence of pre-transplant DM was associated with an increased risk of overall mortality in a multivariate analysis (HR 1.55, 95% CI 1.35–1.78,
P
<0.01). In conclusion, pre-transplant DM was a risk factor for NRM, particularly infection-related mortality, after allogeneic HSCT. To improve the clinical outcome in patients with DM, the benefits of strict infection control and appropriate glycemic control should be explored in future trials.