Significant Improvement in Survival After Allogeneic Hematopoietic Cell Transplantation During a Period of Significantly Increased Use, Older Recipient Age, and Use of Unrelated Donors

Abstract

A B S T R A C T PurposeOver the past four decades, allogeneic hematopoietic cell transplantation (alloHCT) has evolved as a curative modality for patients with hematologic diseases. This study describes changes in use, technique, and survival in a population-based cohort. Patients and MethodsThe study included 38,060 patients with hematologic malignancies or disorders who underwent first alloHCT in a US or Canadian center from 1994 to 2005 and were reported to the Center for International Blood and Marrow Transplant Research. ResultsAlloHCT as treatment for acute lymphoblastic (ALL) and myeloid leukemias (AML), myelodysplastic syndrome (MDS), and Hodgkin and non-Hodgkin lymphomas increased by 45%, from 2,520 to 3,668 patients annually. From 1994 to 2005, use of both peripheral (7% to 6%) and cord blood increased (2% to 10%), whereas use of marrow decreased (90% to 27%). Despite a median age increase from 33 to 40 years and % increase in unrelated donors for alloHCT, overall survival (OS) at day 100 significantly improved for patients with AML in first complete remission after myeloablative sibling alloHCT (85% to 94%; P Ͻ .001) and unrelated alloHCT (63% to 86%; P Ͻ .001); 1-year OS improved among those undergoing unrelated alloHCT (48% to 63%; P ϭ .003) but not among those undergoing sibling alloHCT. Similar results were seen for ALL and MDS. Day-100 OS after cord blood alloHCT improved significantly from 60% to 78% (P Ͻ .001) for AML, ALL, MDS, and chronic myeloid leukemia. Use of reduced-intensity regimens increased, yielding OS rates similar to those of myeloablative regimens. ConclusionSurvival for those undergoing alloHCT has significantly improved over time. However, new approaches are needed to further improve 1-year OS.

Lower dose anti-thymocyte globulin for GvHD prophylaxis results in improved survival after allogeneic stem cell transplantation

“…1,2 Results have improved over the years. 3 Major risks of allogeneic HSCT include GvHD, incomplete immune reconstitution and relapse. GvL effects, as well as GvHD are mediated mainly by donor T lymphocytes.…”

Disparity in perceptions of disease characteristics, treatment effectiveness, and factors influencing treatment adherence between physicians and patients with myelodysplastic syndromes

“…Compared with published series, more patients in this survey had undergone HSCT. 8,16 This difference could be because survey respondents may have had a higher performance status and may have been younger than the average patient with MDS and, thus, were more likely to be HSCT candidates, or because HSCT recipients may have been more invested in their care because of the nature of transplantation and, thus, were more likely to complete the survey.…”

The experience of survival following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia

“…Between 2001-2011, 90,000 allo-HSCTs were performed globally (1), with 4,369 of these performed in Australia (2) . With improvements in donor selection, conditioning therapies and supportive care, more recipients are living longer (3), and up to 85% are expected to be alive at 10 years (4,5).…”