Abstract
OBJECTIVE: We aimed to compare the quality-adjusted time without symptoms or toxicity (Q-TWiST) in acute myeloid leukemia (AML) patients who received haploidentical-related donor (HID) and identical sibling donor (ISD) hematopoietic stem cell transplantation (HSCT). METHODS: Five clinical health states were defined: toxicity (TOX), acute graft-versus-host disease (GVHD), chronic GVHD (cGVHD), time without symptoms and toxicity (TWiST) and relapse (REL). The equation used in this study was as follows: Q-TWiST=U(TOX) × TOX + U(TWiST) × TWiST + U(REL) × REL + U(aGVHD) × aGVHD + U(cGVHD) × cGVHD. RESULTS: A total of 239 AML patients were enrolled. We established a mathematical model, i.e., Q-TWiST HID HSCT > Q-TWiST ISD HSCT, to explore the range of utility coefficients satisfying the inequality. Based on the raw data, the utility coefficient is equivalent to the following inequality: [Formula: see text][Formula: see text]. The model showed that when [Formula: see text], [Formula: see text], and [Formula: see text] were within the range of 0-1, as well as when [Formula: see text] was within the range of 0-0.569, the inequality Q-TWiST HID HSCT > Q-TWiST ISD HSCT was valid. According to the results of the ChiCTR1800016972 study, the median coefficients of TOX, acute GVHD (aGVHD), and cGVHD were 0.56 (0.41-0.76), 0.56 (0.47-0.72), and 0.54 (0.37-0.79), respectively. We selected a series of specific examples of the coefficients, i.e., [Formula: see text]=0.5, [Formula: see text]=0.05, [Formula: see text]=0.5, and [Formula: see text]=0.5. The Q-TWiST values of ISD and HID HSCT were 896 and 900 d, respectively (P=0.470). CONCLUSIONS: We first observed that Q-TWiST was comparable between AML patients receiving HID HSCT and those receiving ISD HSCT.