Reduced Mortality after Allogeneic Hematopoietic-Cell Transplantation

Abstract

Background We tested the hypothesis that changes in our transplant practice have improved outcomes over the last decade. To explore correlates of improved outcomes, we analyzed the frequency and severity of graft-versus-host disease and hepatic, renal, pulmonary and infectious complications. Methods During 1993–1997 and 2003–2007, 1418 and 1148 patients received their first allogeneic transplants at our Center. Outcome measures included non-relapse mortality, recurrent malignancy, overall mortality, and the frequency and severity of major complications across this decade. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for severity of illness at the time of transplantation. Results In comparing outcomes during 1993–1997 and 2003–2007, we observed statistically significant decreases in the hazards of day -200 non-relapse mortality (by 60%), overall non-relapse mortality (by 52%), relapse or progression of malignancy (by 21%), and overall mortality (by 41%), after adjusting for components of the PAM score. Similar results were seen when the analyses were confined to patients receiving myeloablative conditioning therapy. We found statistically significant declines in the risk of more severe GVHD, disease caused by infections (viral, bacterial, and fungal), and damage to the liver, kidneys, and lungs. Conclusions We document a substantial reduction in the hazard of death related to allogeneic hematopoietic cell transplantation as well as improved long-term survival over the last decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD.

Effect of allogeneic hematopoietic cell transplantation in first complete remission on post-relapse complete remission rate and survival in acute myeloid leukemia

“…Patients of Burnett et al were all age < 50 with 23% receiving autologous HCT. 6 Hence, the lack of effect of HCT in CR1 on survival after relapse in our study, but not in that of Breems et al nor that of Burnett et al, may simply reflect an improved ability to manage post allogeneic HCT complications.…”

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

“…1 With improvements in clinical approaches to HCT and supportive care, survival following HCT has improved dramatically. 2–4 The current population of >100,000 survivors in the United States is expected to increase five-fold by 2030, with 14% of the population aged <18 years and 25% aged ≥60 years at transplant. 5 …”

Allogeneic Stem Cell Transplantation for Relapsed/Refractory B Cell Lymphomas: Results of a Multicenter Phase II Prospective Trial including Rituximab in the Reduced-Intensity Conditioning Regimen

“…Severe acute graft-versus-host disease (GVHD) and extensive chronic GVHD (6,7) are the two main complications 32 associated to transplantation and may affect both non-relapse mortality (NRM) and quality of life. In the last years, a 33 better understanding of GVHD biology prompted the design of novel GVHD prophylaxis regimens including the use of 34 post-transplant cyclophosphamide or proteasome inhibitors, but the gold standard is still based on calcineurin inhibitors…”