Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era

Navneet S. Majhail; Pintip Chitphakdithai; Brent Logan; Roberta King; Steven Devine; Susan N. Rossmann; Gregory Hale; Robert J. Hartzman; Chatchada Karanes; Ginna G. Laport; Eneida Nemecek; Edward L. Snyder; Galen E. Switzer; John Miller; Willis Navarro; Dennis L. Confer; John E. Levine

doi:10.1016/j.bbmt.2014.10.001

Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era

Navneet S. Majhail
, Pintip Chitphakdithai
, Brent Logan
, Roberta King
, Steven Devine
, Susan N. Rossmann
, Gregory Hale
, Robert J. Hartzman
, Chatchada Karanes
, Ginna G. Laport
, Eneida Nemecek
, Edward L. Snyder
, Galen E. Switzer
, John Miller
, Willis Navarro
, Dennis L. Confer
, John E. Levine

Pediatric Hematology and Oncology

Research output: Contribution to journal › Article › peer-review

69 Scopus citations

Abstract

Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy because of the mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor hematopoietic cell transplant recipients between 2000 and 2009. We compared outcomes before and after 2005 for 4 cohorts: age <18years with malignant diseases (n=1920), ages 18 to 59years with malignant diseases (n=9575), ages≥60years with malignant diseases (n=2194), and nonmalignant diseases (n=1370). Three-year overall survival in 2005 to 2009 was significantly better in all 4 cohorts (<18years: 55% versus 45%, 18 to 59years: 42% versus 35%, ≥60years: 35% versus 25%, nonmalignant diseases: 69% versus 60%; P < .001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7/8 to 8/8-matched transplants showed significant reduction in overall and nonrelapse mortality in the first year after HCT among patients who underwent transplantation in 2005 to 2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (eg, HCT earlier in the disease course and lower disease risk), improved donor selection (eg, more precise allele-level matched unrelated donors) and changes in transplantation practices.

Original language	English (US)
Pages (from-to)	142-150
Number of pages	9
Journal	Biology of Blood and Marrow Transplantation
Volume	21
Issue number	1
DOIs	https://doi.org/10.1016/j.bbmt.2014.10.001
State	Published - Jan 1 2015

Funding

Financial disclosure : The Center for International Blood and Marrow Transplant Research is supported by Public Health Service grant/cooperative agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a grant/cooperative agreement 5U01HL069294 from NHLBI and NCI ; a contract HHSH234200637015C with Health Resources and Services Administration (HRSA/DHHS); 2 grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research ; and grants from Allos, Inc. ; Amgen, Inc. ; Angioblast; anonymous donation to the Medical College of Wisconsin; Ariad ; Be The Match Foundation ; Blue Cross and Blue Shield Association ; Buchanan Family Foundation ; CaridianBCT ; Celgene Corporation ; CellGenix ; Children's Leukemia Research Association ; Fresenius-Biotech North America, Inc. ; Gamida Cell Teva Joint Venture Ltd .; Genentech, Inc. ; Genzyme Corporation ; GlaxoSmithKline ; HistoGenetics, Inc. ; Kiadis Pharma ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin; Merck & Co, Inc. ; Millennium: The Takeda Oncology Co .; Milliman USA, Inc. ; Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Optum Healthcare Solutions, Inc. ; Osiris Therapeutics, Inc. ; Otsuka America Pharmaceutical, Inc. ; RemedyMD ; Sanofi ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; Soligenix, Inc. ; StemCyte, A Global Cord Blood Therapeutics Co. ; Stemsoft Software, Inc. ; Swedish Orphan Biovitrum ; Tarix Pharmaceuticals ; Teva Neuroscience, Inc. ; Therakos ; and WellPoint The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government.

Funders	Funder number
Allos, Inc.
Amgen Inc.
Children's Leukemia Research Association
Fresenius-Biotech North America, Inc.
Gamida Cell Teva Joint Venture Ltd
HRSA/DHHS	N00014-06-1-0704, N00014-08-1-0058
Office of Naval Research
National Institute of Health National Heart, Lung, and Blood Institute
National Institute of Health-National Cancer Institute	U24CA076518
National Institute of Allergy and Infectious Diseases	5U01HL069294, HHSH234200637015C
Health Resources and Services Administration

Keywords

Hematopoietic cell transplantation
National Marrow Donor Program
Survival
Treatment-related mortality
Unrelated donors

ASJC Scopus subject areas

Hematology
Transplantation

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10.1016/j.bbmt.2014.10.001

Cite this

Majhail, N. S., Chitphakdithai, P., Logan, B., King, R., Devine, S., Rossmann, S. N., Hale, G., Hartzman, R. J., Karanes, C., Laport, G. G., Nemecek, E., Snyder, E. L., Switzer, G. E., Miller, J., Navarro, W., Confer, D. L., & Levine, J. E. (2015). Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era. Biology of Blood and Marrow Transplantation, 21(1), 142-150. https://doi.org/10.1016/j.bbmt.2014.10.001

Majhail, NS, Chitphakdithai, P, Logan, B, King, R, Devine, S, Rossmann, SN, Hale, G, Hartzman, RJ, Karanes, C, Laport, GG, Nemecek, E, Snyder, EL, Switzer, GE, Miller, J, Navarro, W, Confer, DL & Levine, JE 2015, 'Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era', Biology of Blood and Marrow Transplantation, vol. 21, no. 1, pp. 142-150. https://doi.org/10.1016/j.bbmt.2014.10.001

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abstract = "Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy because of the mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor hematopoietic cell transplant recipients between 2000 and 2009. We compared outcomes before and after 2005 for 4 cohorts: age <18years with malignant diseases (n=1920), ages 18 to 59years with malignant diseases (n=9575), ages≥60years with malignant diseases (n=2194), and nonmalignant diseases (n=1370). Three-year overall survival in 2005 to 2009 was significantly better in all 4 cohorts (<18years: 55\% versus 45\%, 18 to 59years: 42\% versus 35\%, ≥60years: 35\% versus 25\%, nonmalignant diseases: 69\% versus 60\%; P < .001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7/8 to 8/8-matched transplants showed significant reduction in overall and nonrelapse mortality in the first year after HCT among patients who underwent transplantation in 2005 to 2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (eg, HCT earlier in the disease course and lower disease risk), improved donor selection (eg, more precise allele-level matched unrelated donors) and changes in transplantation practices.",

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AU - Devine, Steven

AU - Rossmann, Susan N.

AU - Hale, Gregory

AU - Hartzman, Robert J.

AU - Karanes, Chatchada

AU - Laport, Ginna G.

AU - Nemecek, Eneida

AU - Snyder, Edward L.

AU - Switzer, Galen E.

AU - Miller, John

AU - Navarro, Willis

AU - Confer, Dennis L.

AU - Levine, John E.

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N2 - Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy because of the mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor hematopoietic cell transplant recipients between 2000 and 2009. We compared outcomes before and after 2005 for 4 cohorts: age <18years with malignant diseases (n=1920), ages 18 to 59years with malignant diseases (n=9575), ages≥60years with malignant diseases (n=2194), and nonmalignant diseases (n=1370). Three-year overall survival in 2005 to 2009 was significantly better in all 4 cohorts (<18years: 55% versus 45%, 18 to 59years: 42% versus 35%, ≥60years: 35% versus 25%, nonmalignant diseases: 69% versus 60%; P < .001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7/8 to 8/8-matched transplants showed significant reduction in overall and nonrelapse mortality in the first year after HCT among patients who underwent transplantation in 2005 to 2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (eg, HCT earlier in the disease course and lower disease risk), improved donor selection (eg, more precise allele-level matched unrelated donors) and changes in transplantation practices.

AB - Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy because of the mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor hematopoietic cell transplant recipients between 2000 and 2009. We compared outcomes before and after 2005 for 4 cohorts: age <18years with malignant diseases (n=1920), ages 18 to 59years with malignant diseases (n=9575), ages≥60years with malignant diseases (n=2194), and nonmalignant diseases (n=1370). Three-year overall survival in 2005 to 2009 was significantly better in all 4 cohorts (<18years: 55% versus 45%, 18 to 59years: 42% versus 35%, ≥60years: 35% versus 25%, nonmalignant diseases: 69% versus 60%; P < .001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7/8 to 8/8-matched transplants showed significant reduction in overall and nonrelapse mortality in the first year after HCT among patients who underwent transplantation in 2005 to 2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (eg, HCT earlier in the disease course and lower disease risk), improved donor selection (eg, more precise allele-level matched unrelated donors) and changes in transplantation practices.

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Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era

Abstract

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Keywords

ASJC Scopus subject areas

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