Pre-transplant testosterone and outcome of men after allogeneic stem cell transplantation

Testosteroneis an important determinant of endothelial function and vascular health in men. As both factors play a role for mortality after allogeneic stem cell transplantation, we retrospectively evaluated the impact of pre-transplant testosteronelevels on outcome in male patients undergoing allogeneic stem cell transplantation. In the discovery cohort(n=346), an impact on outcome was observed only in the subgroup of patients allografted for acute myeloid leukemia(n=176, hereafter termed training cohort). In the training cohort, lower pre-transplant testosteronelevels were significantly associated with shorter overall survival ( hazard ratiofor a decrease of 100 ng/dL, 1.11, P=0.045). This was based on a higher hazardof non-relapse mortality (cause-specific hazard ratio1.25, P=0.013), but not relapse (cause-specific hazard ratio1.06, P=0.277) in the multivariable models. These findings were replicated in a confirmation cohortof 168 male patients allografted for acute myeloid leukemiain a different center (overall survival, hazard ratio1.15, P=0.012 and non-relapse mortality, cause-specific hazard ratio1.23, P=0.008). Next, an optimized cut-off point for pre-transplant testosteronewas derived in the training set and evaluated in the confirmation cohort. In multivariable models, low pre-transplant testosteronestatus (