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Testosterone and post-transplant outcome of men
    Table 5. Multivariable analysis of the confirmation cohort with optimized pre-transplant testosterone cut-off value (complete case analysis).
        OS PFS NRM Relapse OS after (n=165) (n=165) (n=165) (n=165) acute GvHD*
(n=127)
HR95%CI P HR95%CI P CHR95%CI P CHR95%CI P HR95%CI P HR95%CI P
Co-variate Testosterone
<250 ng/dL
Disease stage†
Early Intermediate
Late
Age (per 10-year increase) Conditioning
Donor
Relateddonor Ref Ref Ref Ref - - Unrelated Donor 1.19 0.91 1.25 0.72
(0.64-2.22) 0.579 (0.52-1.61) 0.753 (0.50-3.13) 0.634 (0.35-1.49) 0.375
≥250ng/dL Ref Ref Ref Ref Ref Ref
1.95 1.81 2.68 1.28 2.29 2.29 (1.11-3.43) 0.021 (1.05-3.12) 0.033 (1.25-5.74) 0.011 (0.57-2.84) 0.551 (1.27-4.12) 0.006 (1.29-4.10) 0.005
Ref Ref Ref Ref Ref Ref
1.67 1.62 2.04 1.35 2.12 1.90 (0.96-2.93) 0.072 (0.95-2.75) 0.076 (0.92-4.51) 0.079 (0.66-2.77) 0.417 (1.13-3.96) 0.019 (1.05-3.42) 0.033
2.53 2.46 3.09 2.04 3.27 3.09
PFS after acute GvHD* (n=126)
         (1.51-4.23) <0.001 (1.51-4.00) <0.001 (1.51-6.33) 0.002 (1.03-4.05) 0.042
1.12 1.10 1.28 0.98 1.23 1.17
(0.91-1.39) 0.280 (0.90-1.35) 0.353 (0.93-1.64) 0.121 (0.68-1.28) 0.873
(0.99-1.53) 0.065 (0.96-1.43) 0.117
(1.80-5.93) <0.001 (1.76-5.40) <0.001
 MAC Ref Ref Ref Ref - - RIC 1.79 1.63 1.62 1.69
(0.88-3.67) 0.110 (0.84-3.15) 0.146 (0.56-4.64) 0.370 (0.71-4.01) 0.233
    Recipient - donor sex match
Matched Ref Ref Ref Ref -- Male recipient / 1.57 1.13 1.45 0.93
   femaledonor Donor source
PB BM
(0.93-2.65) 0.094 (0.67-1.91) 0.643 (0.70-3.00) 0.316 (0.44-1.98) 0.854
Ref Ref Ref Ref - -
1.42 1.92 1.59 2.01
(0.53-3.78) 0.485 (0.83-4.42) 0.125 (0.35-7.30) 0.551 (0.74-5.49) 0.173
 Numberofevents:OS,n=87;PFS,n=97;NRM,n=46,relapse,n=51;OSafteracuteGvHD,n=67;PFSafteracuteGvHD,n=75.*Slimmodel.†AccordingtoGratwohletal.13 Numberof events:OS,n=87;PFS,n=97;NRM,n=46;relapse,n=51;OSafteracuteGvHD,n=67;PFSafteracuteGvHD,n=75.*Slimmodel.†AccordingtoGratwohletal.13 PFS:progression-free survival; BM: bone marrow; CHR: cause-specific hazard ratio; CI: confidence interval; GvHD: graft-versus-host disease; HR: hazard ratio; MAC: myeloablative conditioning; PB: peripheral blood; RIC: reduced intensity conditioning; OS: overall survival; NRM: non-relapse mortality.
AML. Considering recent successful post-remission andro- gen maintenance treatment approaches in AML,12 and the fact that an individual’s testosterone status is modifiable, our results may provide a rationale for the design of inter- ventional clinical studies evaluating testosterone/andro- gen status and supplementation in patients undergoing alloSCT.
Acknowledgments
The authors wish to acknowledge the great work of the physi- cians and the nursing staff of both transplant units and the
patients for making the study possible. The authors thank Michael Hess and Alexandra Hof for their expert technical assis- tance, and the construction and maintenance of the serum biobank. We would also like to acknowledge the help of Markus Zorn at the Department of Clinical Chemistry of the Heidelberg University Hospital and the help of Ina Rehberger at the Steroid Lab of the Institute of Pharmacology, University Heidelberg.
Funding
This work was supported by B.L.U.T. e.V. (Weingarten, Germany).
References
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2. Cooke KR, Jannin A, Ho V. The contribu- tion of endothelial activation and injury to end-organ toxicity following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2008;14(1
Suppl 1):23-32.
3. Luft T, Dietrich S, Falk C, et al. Steroid-
refractory GvHD: T-cell attack within a vulnerable endothelial system. Blood. 2011;118(6):1685-1692.
4. Radujkovic A, Dai H, Kordelas L, et al.
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