How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT
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How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT. / Penack, Olaf; Peczynski, Christophe; Mohty, Mohamad; Yakoub-Agha, Ibrahim; Styczynski, Jan; Montoto, Silvia; Duarte, Rafael F; Kröger, Nicolaus; Schoemans, Hélène; Koenecke, Christian; Peric, Zinaida; Basak, Grzegorz W.
In: Blood Adv, Vol. 4, No. 24, 22.12.2020, p. 6283-6290.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT
AU - Penack, Olaf
AU - Peczynski, Christophe
AU - Mohty, Mohamad
AU - Yakoub-Agha, Ibrahim
AU - Styczynski, Jan
AU - Montoto, Silvia
AU - Duarte, Rafael F
AU - Kröger, Nicolaus
AU - Schoemans, Hélène
AU - Koenecke, Christian
AU - Peric, Zinaida
AU - Basak, Grzegorz W
N1 - © 2020 by The American Society of Hematology.
PY - 2020/12/22
Y1 - 2020/12/22
N2 - We performed a study to find out how advances in modern medicine have improved the mortality risk of allogeneic stem cell transplantation. We analyzed major transplantation outcome parameters in adult patients on the European Society for Blood and Marrow Transplantation (EBMT) registry who had hematologic malignancies and had received transplants from matched sibling donors. We performed multivariate analyses using the Cox proportional-hazards model including known risk factors for nonrelapse mortality and a matched-pairs analysis. We identified 38 800 patients who fulfilled the inclusion criteria. Considerable changes in patient characteristics have occurred in the past decades, such as older age, different underlying diseases, and a higher proportion of patients with advanced disease. Major reasons for transplantation-related death in the 1980s were infectious complications and graft-versus-host disease. Nonrelapse mortality, measured at 1 year after transplantation, has decreased over time: 29.7% from 1980 through 1989, 24.4% from 1990 through 1999, 14.8% from 2000 through 2009, and 12.2% from 2010 through 2016. On multivariate analysis, the year of transplantation was associated with reduced nonrelapse mortality (P < .0001; hazard ratio [HR] [95% confidence interval (CI)], 0.8 [0.79-0.82], for 5-year intervals) and decreased overall mortality (P < .0001; HR [95% CI], 0.87 [0.86-0.88]. In the matched-pairs analysis of 3718 patients in each group, nonrelapse mortality at 1 year was 24.4% in the 1990s and 9.5% from 2013 through 2016 (P < .0001; HR [95% CI], 0.39 [0.34-0.43]). Transplantation-related mortality has decreased significantly in the past 40 years. These favorable data facilitate evidence-based treatment decisions on transplantation indications in the context of the availability of novel immunotherapies.
AB - We performed a study to find out how advances in modern medicine have improved the mortality risk of allogeneic stem cell transplantation. We analyzed major transplantation outcome parameters in adult patients on the European Society for Blood and Marrow Transplantation (EBMT) registry who had hematologic malignancies and had received transplants from matched sibling donors. We performed multivariate analyses using the Cox proportional-hazards model including known risk factors for nonrelapse mortality and a matched-pairs analysis. We identified 38 800 patients who fulfilled the inclusion criteria. Considerable changes in patient characteristics have occurred in the past decades, such as older age, different underlying diseases, and a higher proportion of patients with advanced disease. Major reasons for transplantation-related death in the 1980s were infectious complications and graft-versus-host disease. Nonrelapse mortality, measured at 1 year after transplantation, has decreased over time: 29.7% from 1980 through 1989, 24.4% from 1990 through 1999, 14.8% from 2000 through 2009, and 12.2% from 2010 through 2016. On multivariate analysis, the year of transplantation was associated with reduced nonrelapse mortality (P < .0001; hazard ratio [HR] [95% confidence interval (CI)], 0.8 [0.79-0.82], for 5-year intervals) and decreased overall mortality (P < .0001; HR [95% CI], 0.87 [0.86-0.88]. In the matched-pairs analysis of 3718 patients in each group, nonrelapse mortality at 1 year was 24.4% in the 1990s and 9.5% from 2013 through 2016 (P < .0001; HR [95% CI], 0.39 [0.34-0.43]). Transplantation-related mortality has decreased significantly in the past 40 years. These favorable data facilitate evidence-based treatment decisions on transplantation indications in the context of the availability of novel immunotherapies.
U2 - 10.1182/bloodadvances.2020003418
DO - 10.1182/bloodadvances.2020003418
M3 - SCORING: Journal article
C2 - 33351121
VL - 4
SP - 6283
EP - 6290
JO - BLOOD ADV
JF - BLOOD ADV
SN - 2473-9529
IS - 24
ER -