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)
Por:
Schetelig, J, de Wreede, LC, Andersen, NS, Moreno, C, van Gelder, M, Vitek, A, Karas, M, Michallet, M, Machaczka, M, Gramatzki, M, Beelen, D, Finke, J, Delgado, J, Volin, L, Passweg, J, Dreger, P, Schaap, N, Wagner, E, Henseler, A, van Biezen, A, Bornhauser, M, Iacobelli, S, Putter, H, Schonland, SO, Kroger, N
Publicada:
1 ago 2017
Resumen:
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.
Filiaciones:
Schetelig, J:
Tech Univ Dresden, Univ Hosp, Med Dept 1, Dresden, Germany
DKMS Clin Trials Unit, Dresden, Germany
de Wreede, LC:
DKMS Clin Trials Unit, Dresden, Germany
Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
Andersen, NS:
Rigshosp, Dept Haematol, BMT Unit, Copenhagen, Denmark
Moreno, C:
Hosp Santa Creu & Sant Pau, Hematol, Barcelona, Spain
van Gelder, M:
Univ Med Ctr Maastricht, Maastricht, Netherlands
Vitek, A:
Inst Hematol & Blood Transfus, Dept Haematol, Prague, Czech Republic
Karas, M:
Charles Univ Prague, Dept Haematol Oncol, Plzen, Czech Republic
Michallet, M:
Ctr Hosp Lyon Sud, Haematol, Lyon, France
Machaczka, M:
Karolinska Inst, Haematol Ctr Karolinska, Stockholm, Sweden
Karolinska Inst, Dept Med Huddinge, Stockholm, Sweden
Gramatzki, M:
Univ Hosp Schleswig Holstein, Div Stem Cell Transplantat & Immunotherapy, Kiel, Germany
Beelen, D:
Univ Hosp, Dept Bone Marrow Transplantat, Essen, Germany
Finke, J:
Univ Freiburg, Dept Med Haematol Oncol, Freiburg, Germany
Delgado, J:
Hosp Clin Barcelona, Dept Haematol, Inst Haematol & Oncol, Barcelona, Spain
Volin, L:
Univ Helsinki, Hosp Comprehens Canc Ctr, Stem Cell Transplantat Unit, Helsinki, Finland
Passweg, J:
Univ Hosp, Dept Haematol, Basel, Switzerland
Dreger, P:
Heidelberg Univ, Med Klin & Poliklin 5, Heidelberg, Germany
Schaap, N:
Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands
Wagner, E:
Univ Med Ctr Mainz, Mainz, Germany
Henseler, A:
Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
van Biezen, A:
Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
Bornhauser, M:
Tech Univ Dresden, Univ Hosp, Med Dept 1, Dresden, Germany
Iacobelli, S:
Univ Tor Vergata, Dept Biol, Rome, Italy
Putter, H:
Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands
Schonland, SO:
Inst Hematol & Blood Transfus, Dept Haematol, Prague, Czech Republic
Kroger, N:
Univ Hosp Eppendorf, Bone Marrow Transplantat Ctr, Hamburg, Germany
Green Submitted, Bronze
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