Publications by authors named "Kwang-Woo Ahn"

Competing risks data in clinical trial or observational studies often suffer from cluster effects such as center effects and matched pairs design. The proportional subdistribution hazards (PSH) model is one of the most widely used methods for competing risks data analyses. However, the current literature on the PSH model for clustered competing risks data is limited to covariate-independent censoring and the unstratified model.

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Observational studies with right-censored data often have clustered data due to matched pairs or a study center effect. In such data, there may be an imbalance in patient characteristics between treatment groups, where Kaplan-Meier curves or unadjusted cumulative incidence curves can be misleading and may not represent the average patient on a given treatment arm. Adjusted curves are desirable to appropriately display survival or cumulative incidence curves in this case.

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Investigators often face ultra-high dimensional multi-omics data, where identifying significant genes and omics within a gene is of interest. In such data, each gene forms a group consisting of its multiple omics. Moreover, some genes may also be highly correlated.

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In biomedical studies, investigators often encounter clustered data. The cluster sizes are said to be informative if the outcome depends on the cluster size. Ignoring informative cluster sizes in the analysis leads to biased parameter estimation in marginal and mixed-effect regression models.

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Article Synopsis
  • Diffuse alveolar hemorrhage (DAH) is a serious lung complication that can occur after hematopoietic cell transplantation (HCT) in patients under 21, with a low incidence rate of about 1% in this population.
  • A study analyzed data from nearly 7,000 patients to identify risk factors for developing DAH, finding that nonmalignant hematologic disease, specific transplant medication regimens, and severe acute graft-versus-host disease significantly increased the risk.
  • Critical care patients with DAH also showed higher instances of various health issues, including systemic and pulmonary hypertension, and other serious conditions like renal failure.
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Gene pathways and gene-regulatory networks are used to describe the causal relationship between genes, based on biological experiments. However, many genes are still to be studied to define novel pathways. To address this, a gene-clustering algorithm has been used to group correlated genes together, based on the similarity of their gene expression level.

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  • A study examined the incidence, risk factors, and outcomes of pulmonary hypertension (PH) in pediatric patients after hematopoietic stem cell transplants (HCT) conducted in a PICU setting from 2008 to 2014.
  • Out of nearly 7,000 HCT patients, 29 developed PH, revealing a low overall incidence of 0.42%, but a higher prevalence of 2.72% among patients needing intensive care post-transplant.
  • Key risk factors for developing PH included being Black/African American, having metabolic disorders, and a lower functional status prior to transplant, with patients experiencing significant complications and a 6-month survival rate of only 51.7% after PH diagnosis.
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The case-cohort study design provides a cost-effective study design for a large cohort study with competing risk outcomes. The proportional subdistribution hazards model is widely used to estimate direct covariate effects on the cumulative incidence function for competing risk data. In biomedical studies, left truncation often occurs and brings extra challenges to the analysis.

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Background: Studies examining the association between asthma and hospitalization among children and youth with coronavirus disease 2019 (COVID-19) have yielded mixed results. Both asthma and COVID-19 hospitalization are characterized by racial, ethnic and socioeconomic disparities which also pattern geographically, yet no studies to date have adjusted for neighborhood context in the assessment of this association.

Methods: Mixed effects logistic regression was used to estimate the association between asthma and hospitalization due to COVID-19 in a sample of 28,997 children and youth diagnosed with COVID-19 in Milwaukee County, Wisconsin, from March 1, 2020, to May 31, 2022.

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It is common to study time-to-event data in cancer research such as hematopoietic cell transplantation (HCT) for leukemia. The extensive work has been done for the univariate survival outcome, that is, one event type. However, in practice a subject is often exposed to multiple types of outcomes.

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Sample size and power determination are crucial design considerations for biomedical studies intending to formally test the effects of key variables on an outcome. Other known prognostic factors may exist, necessitating the use of techniques for covariate adjustment when conducting this evaluation. Moreover, the main interest often includes assessing the impact of more than one variable on an outcome, such as multiple treatments or risk factors.

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Article Synopsis
  • Researchers created a prognostic model to predict outcomes for patients with myelofibrosis undergoing allogeneic hematopoietic cell transplantation by analyzing data from 623 patients in the U.S. (CIBMTR cohort) from 2000 to 2016.
  • They identified key factors that influence mortality, assigning weighted scores based on age, donor matching, hemoglobin levels, and donor compatibility, which resulted in differing survival rates among low, intermediate, and high score groupings.
  • The model was validated in a European cohort (EBMT), proving effective for predicting overall survival and transplant-related mortality, aiding clinicians in discussing transplantation prospects with myelofibrosis patients.
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At the onset of the COVID-19 pandemic, the National Marrow Donor Program mandated the cryopreservation of hematopoietic cell grafts from volunteer unrelated donors because of numerous patient and donor safety concerns and logistical hurdles. Using the Center for International Blood and Marrow Transplant Research outcomes database, we report the impact of cryopreservation on overall survival (OS) and other outcomes within 1 year after hematopoietic cell transplantation (HCT). We analyzed 1543 recipients of cryopreserved allografts receiving HCT at US centers during the first 6 months of the pandemic and compared them with 2499 recipients of fresh allografts during a 6-month period in 2019.

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Consolidation with autologous hematopoietic stem cell transplantation (HSCT) has improved survival for patients with central nervous system tumors (CNSTs). The impact of the autologous graft CD34+ dose on patient outcomes is unknown. We wanted to analyze the relationship between CD34 dose, total nucleated cell (TNC) dose, and clinical outcomes, including overall survival (OS), progression-free survival (PFS), relapse, non-relapse mortality (NRM), endothelial-injury complications (EIC), and time to neutrophil engraftment in children undergoing autologous HSCT for CNSTs.

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Multivariate survival models are often used in studying multiple outcomes for right-censored data. However, the outcomes of interest often have competing risks, where standard multivariate survival models may lead to invalid inferences. For example, patients who had stem cell transplantation may experience multiple types of infections after transplant while reconstituting their immune system, where death without experiencing infections is a competing risk for infections.

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There is a lack of evidence about how health-related quality of life (HRQoL), including psychosocial factors, might affect donation-related experiences and clinical markers in the context of hematopoietic stem cell donation. The broader literature suggests that psychological factors, including anxiety and depression, are associated with higher levels of inflammatory burden leading to poorer postprocedural outcomes including longer hospital stays and increased pain perception. In this study, we aimed to evaluate whether predonation HRQoL markers predict toxicity profile and stem cell yield after peripheral blood stem cell (PBSC) donation in healthy donors.

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Article Synopsis
  • Noninfectious pulmonary toxicity (NPT) is a serious complication of allogeneic hematopoietic cell transplantation (alloHCT) that includes conditions like idiopathic pneumonia syndrome (IPS), diffuse alveolar hemorrhage (DAH), and cryptogenic organizing pneumonia (COP), with a 1-year cumulative incidence of about 8.1%.
  • A study evaluated NPT's incidence and risk factors among 21,574 adult patients who underwent alloHCT from 2008 to 2017, revealing that factors such as severe pulmonary comorbidity, acute graft-versus-host disease (GVHD), and mismatched donor transplants significantly increase the risk of NPT.
  • The findings emphasize that understanding these risk factors
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It is not known whether obesity has a differential effect on allogeneic haematopoietic cell transplantation outcomes with alternative donor types. We report the results of a retrospective registry study examining the effect of obesity [body mass index (BMI) > 30] on outcomes with alternative donors (haploidentical related donor with two or more mismatches and receiving post-transplant cyclophosphamide [haplo] and cord blood (CBU)] versus matched unrelated donor (MUD). Adult patients receiving haematopoietic cell transplantation for haematologic malignancy (2013-2017) (N = 16 182) using MUD (n = 11 801), haplo (n = 2894) and CBU (n = 1487) were included.

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  • T cell prolymphocytic leukemia (T-PLL) is a rare and aggressive cancer with limited treatment options and poor survival rates, prompting this study to evaluate allogeneic hematopoietic cell transplantation (alloHCT) outcomes in affected patients.* -
  • The analysis utilized data from 266 T-PLL patients who underwent alloHCT from 2008 to 2018, revealing a 4-year overall survival rate of 30% and highlighting significant factors affecting survival, including the conditioning regimen and patient age.* -
  • Findings indicated that myeloablative conditioning and poor performance status lead to worse survival and increased treatment-related mortality, while stable disease or progression correlated with a higher relapse risk, suggesting
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A generalized case-cohort design has been used when measuring exposures is expensive and events are not rare in the full cohort. This design collects expensive exposure information from a (stratified) randomly selected subset from the full cohort, called the subcohort, and a fraction of cases outside the subcohort. For the full cohort study with competing risks, He et al.

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Missing covariates are commonly encountered when evaluating covariate effects on survival outcomes. Excluding missing data from the analysis may lead to biased parameter estimation and a misleading conclusion. The inverse probability weighting method is widely used to handle missing covariates.

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The relative efficacy of autologous hematopoietic cell transplant (auto-HCT) vs chimeric antigen receptor T-cell (CAR-T) therapy in patients with diffuse large B-cell lymphoma (DLBCL) who achieve a partial remission (PR) after salvage chemotherapy is not known. Using the Center for International Blood & Marrow Transplant Research registry database, we identified adult patients with DLBCL who received either an auto-HCT (2013-2019) or CAR-T treatment with axicabtagene ciloleucel (2018-2019) while in a PR by computed tomography or positron emission tomography scan. We compared the clinical outcomes between the 2 cohorts using univariable and multivariable regression models after adjustment for relevant baseline and clinical factors.

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