Statin Use and Its Effects on Survival Outcomes and Rates of Gvhd in Allogeneic Stem Cell Transplant Patients: Results from Real-World Cohorts

Introduction:

The effect of statin use in allogeneic stem cell transplant remains unclear. There have been conflicting results in studies examining the impact of statins on engraftment, graft-versus-host-disease, survival, and long-term outcomes in stem cell transplant recipients.

Methods:

Retrospective data was extracted using the TriNetX database. The primary endpoint was overall survival at 5 years, risk of death, and graft-versus-host-disease in the two cohorts.

Results:

5045 patients were identified in cohort-1 (statin cohort) and 10,181 patients were identified in cohort-2 (non-statin cohort). Table-1 shows patient characteristics at baseline. Propensity-score-matching was used to balance the two cohorts. Patient count in each group after matching was 3702 (Table-2). Overall survival was 59.32% in cohort-1 versus 48.55 % in cohort-2, with HR of 0.685 (95% CI 0.634, 0.740) in favor of cohort 1 (Figure-1). Median OS for cohort-1 was not reached versus 1593 days for cohort-2. Risk of death in cohort-1 and 2 was 0.311 and 0.4 respectively (Figure-2), with a risk difference for the death of -0.089 (95% CI, -0.110, -0.067, p-value <0.001), in favor of cohort-1. Risk of graft-versus-host-disease was 0.648 and 0.674 in cohort-1 and 2 respectively (Figure-3), with a risk difference of -0.026 (95% CI -0.054, 0.002, p-value 0.065), and risk ratio of 0.961 (95% CI 0.921, 1.003). Survival-probability was higher at 5 years in cohort-1 regardless of presence or absence of GVHD.

Conclusions:

Our retrospective analysis of a large patient cohort showed improved OS and decreased risk of death with statin use in allogeneic stem cell transplant patients, regardless of presence or absence of GVHD, even though the average total and LDL cholesterol levels were higher in statin-group. The difference in graft-versus-host-disease was not statistically significant in both cohorts, however, there was a trend towards decrease GVHD in statin-cohort. To the best of our knowledge, this is the first large database based study evaluating the effect of statin use on outcomes in patients undergoing allogeneic stem cell transplant. Phase 3 clinical trials are needed to further answer this question.