Survival, nonrelapse mortality, and relapse-related mortality after allogeneic hematopoietic cell transplantation: comparing 2003–2007 versus 2013–2017 cohorts
GB McDonald, BM Sandmaier, M Mielcarek… - Annals of internal …, 2020 - acpjournals.org
Annals of internal medicine, 2020•acpjournals.org
Background: Allogeneic hematopoietic cell transplantation is indicated for refractory
hematologic cancer and some nonmalignant disorders. Survival is limited by recurrent
cancer and organ toxicity. Objective: To determine whether survival has improved over the
past decade and note impediments to better outcomes. Design: The authors compared
cohorts that had transplants during 2003 to 2007 versus 2013 to 2017. Survival outcome
measures were analyzed, along with transplant-related complications. Setting: A center …
hematologic cancer and some nonmalignant disorders. Survival is limited by recurrent
cancer and organ toxicity. Objective: To determine whether survival has improved over the
past decade and note impediments to better outcomes. Design: The authors compared
cohorts that had transplants during 2003 to 2007 versus 2013 to 2017. Survival outcome
measures were analyzed, along with transplant-related complications. Setting: A center …
Background
Allogeneic hematopoietic cell transplantation is indicated for refractory hematologic cancer and some nonmalignant disorders. Survival is limited by recurrent cancer and organ toxicity.
Objective
To determine whether survival has improved over the past decade and note impediments to better outcomes.
Design
The authors compared cohorts that had transplants during 2003 to 2007 versus 2013 to 2017. Survival outcome measures were analyzed, along with transplant-related complications.
Setting
A center performing allogeneic transplant procedures.
Participants
All recipients of a first allogeneic transplant during 2003 to 2007 and 2013 to 2017.
Intervention
Patients received a conditioning regimen, infusion of donor hematopoietic cells, then immunosuppressive drugs and antimicrobial approaches to infection control.
Measurements
Day-200 nonrelapse mortality (NRM), recurrence or progression of cancer, relapse-related mortality, and overall mortality, adjusted for comorbidity scores, source of donor cells, donor type, patient age, disease severity, conditioning regimen, patient and donor sex, and cytomegalovirus serostatus.
Results
During the 2003-to-2007 and 2013-to-2017 periods, 1148 and 1131 patients, respectively, received their first transplant. Over the decade, decreases were seen in the adjusted hazards of day-200 NRM (hazard ratio [HR], 0.66 [95% CI, 0.48 to 0.89]), relapse of cancer (HR, 0.76 [CI, 0.61 to 0.94]), relapse-related mortality (HR, 0.69 [CI, 0.54 to 0.87]), and overall mortality (HR, 0.66 [CI, 0.56 to 0.78]). The degree of reduction in overall mortality was similar for patients who received myeloablative versus reduced-intensity conditioning, as well as for patients whose allograft came from a matched sibling versus an unrelated donor. Reductions were also seen in the frequency of jaundice, renal insufficiency, mechanical ventilation, high-level cytomegalovirus viremia, gram-negative bacteremia, invasive mold infection, acute and chronic graft-versus-host disease, and prednisone exposure.
Limitation
Cohort studies cannot determine causality, and current disease severity criteria were not available for patients in the 2003-to-2007 cohort.
Conclusion
Improvement in survival and reduction in complications were substantial after allogeneic transplant. Relapse of cancer remains the largest obstacle to better survival outcomes.
Primary Funding Source
National Institutes of Health.
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