Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors

Over 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. The study included 38,060 patients with hematologi...

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Bibliographic Details
Published in:Journal of clinical oncology Vol. 31; no. 19; p. 2437
Main Authors: Hahn, Theresa, McCarthy, Jr, Philip L, Hassebroek, Anna, Bredeson, Christopher, Gajewski, James L, Hale, Gregory A, Isola, Luis M, Lazarus, Hillard M, Lee, Stephanie J, Lemaistre, Charles F, Loberiza, Fausto, Maziarz, Richard T, Rizzo, J Douglas, Joffe, Steven, Parsons, Susan, Majhail, Navneet S
Format: Journal Article
Language:English
Published: United States 01.07.2013
Subjects:
Adolescent
Adult
Age Factors
Aged
Canada - epidemiology
Child
Child, Preschool
Cohort Studies
Female
Hematologic Neoplasms - mortality
Hematologic Neoplasms - surgery
Hematopoietic Stem Cell Transplantation - utilization
Hodgkin Disease - mortality
Hodgkin Disease - surgery
Humans
Infant
Leukemia, Myeloid, Acute - mortality
Leukemia, Myeloid, Acute - surgery
Lymphoma, Non-Hodgkin - mortality
Lymphoma, Non-Hodgkin - surgery
Male
Middle Aged
Myelodysplastic Syndromes - mortality
Myelodysplastic Syndromes - surgery
Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery
Retrospective Studies
SEER Program
Survival Analysis
Survival Rate
Transplantation, Homologous
United States - epidemiology
Unrelated Donors
Canada
United States
ISSN:1527-7755, 1527-7755
Online Access:Get more information
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Summary:Over 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. The 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. AlloHCT 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 63%) [corrected] 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 165% [corrected] 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 < .001) and unrelated alloHCT (63% to 86%; P < .001); 1-year OS improved among those undergoing unrelated alloHCT (48% to 63%; P = .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 < .001) for AML, ALL, MDS, and chronic myeloid leukemia. Use of reduced-intensity regimens increased, yielding OS rates similar to those of myeloablative regimens. Survival for those undergoing alloHCT has significantly improved over time. However, new approaches are needed to further improve 1-year OS.
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ISSN:1527-7755
1527-7755
DOI:10.1200/JCO.2012.46.6193