Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT)
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Multicenter Study
PubMed
28589551
DOI
10.1111/bjh.14791
Knihovny.cz E-resources
- Keywords
- allogeneic stem cell transplantation, centre effects, chronic lymphocytic leukaemia, frailties, risk factor analysis,
- MeSH
- Leukemia, Lymphocytic, Chronic, B-Cell mortality therapy MeSH
- Adult MeSH
- Kaplan-Meier Estimate MeSH
- Karnofsky Performance Status MeSH
- Middle Aged MeSH
- Humans MeSH
- Professional Practice statistics & numerical data MeSH
- Delivery of Health Care statistics & numerical data MeSH
- Transplantation Conditioning methods MeSH
- Recurrence MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged MeSH
- Hematopoietic Stem Cell Transplantation methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe epidemiology MeSH
The best approach for allogeneic haematopoietic stem cell transplantations (alloHCT) in patients with chronic lymphocytic leukaemia (CLL) is unknown. We therefore analysed the impact of procedure- and centre-related factors on 5-year event-free survival (EFS) in a large retrospective study. Data of 684 CLL patients who received a first alloHCT between 2000 and 2011 were analysed by multivariable Cox proportional hazards models with a frailty component to investigate unexplained centre heterogeneity. Five-year EFS of the whole cohort was 37% (95% confidence interval [CI], 34-42%). Larger numbers of CLL alloHCTs (hazard ratio [HR] 0·96, P = 0·002), certification of quality management (HR 0·7, P = 0·045) and a higher gross national income per capita (HR 0·4, P = 0·04) improved EFS. In vivo T-cell depletion (TCD) with alemtuzumab compared to no TCD (HR 1·5, P = 0·03), and a female donor compared to a male donor for a male patient (HR 1·4, P = 0·02) had a negative impact on EFS, but not non-myeloablative versus more intensive conditioning. After correcting for patient-, procedure- and centre-characteristics, significant variation in centre outcomes persisted. In conclusion, further research on the impact of centre and procedural characteristics is warranted. Non-myeloablative conditioning appears to be the preferable approach for patients with CLL.
BMT Unit Department of Haematology Rigshospitalet Copenhagen Denmark
Bone Marrow Transplantation Centre University Hospital Eppendorf Hamburg Germany
Centre Hospitalier Lyon Sud Hématologie Lyon France
Department for Haematology University Hospital Basel Switzerland
Department of Biology University of Tor Vergata Rome Italy
Department of Bone Marrow Transplantation University Hospital Essen Germany
Department of Haematology Institute of Haematology and Blood Transfusion Prague Czech Republic
Department of Haematology Oncology Charles University Hospital Pilsen Czech Republic
Department of Medicine Haematology Oncology University of Freiburg Freiburg Germany
DKMS Clinical Trials Unit Dresden Germany
Hematologia Hospital de la Santa Creu i Sant Pau Barcelona Spain
Institute of Haematology and Oncology Department of Haematology Hospital Clinic Barcelona Spain
Medical Department 1 University Hospital of the Technical University Dresden Dresden Germany
Medizinische Klinik u Poliklinik 5 University of Heidelberg Heidelberg Germany
Radboud University Medical Centre Nijmegen the Netherlands
University Medical Centre Maastricht Maastricht The Netherlands
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