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. 2020 Dec 22;4(24):6283-6290.
doi: 10.1182/bloodadvances.2020003418.

How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT

Olaf Penack  1   2 , Christophe Peczynski  2   3 , Mohamad Mohty  4   5 , Ibrahim Yakoub-Agha  6   7 , Jan Styczynski  8   9 , Silvia Montoto  10   11 , Rafael F Duarte  12 , Nicolaus Kröger  13 , Hélène Schoemans  2   14 , Christian Koenecke  2   15 , Zinaida Peric  2   16 , Grzegorz W Basak  2   17
Affiliations

How much has allogeneic stem cell transplant-related mortality improved since the 1980s? A retrospective analysis from the EBMT

Olaf Penack et al. Blood Adv. .

Abstract

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.

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Conflict of interest statement

Conflict-of-interest disclosure: Between 2017 and 2020, H.S. participated in advisory boards for Incyte (2018) and Janssen and Novartis (2020); received speaker’s fees from Jazz Pharmaceuticals (2017), Novartis and Incyte (2018), and Incyte, Jazz Pharmaceuticals, and Takeda (2019); received travel grants from EBMT (2017), EBMT, Celgene, and Abbvie (2018), EBMT and Incyte (2019), and EBMT and Gilead (2020); and received research funding from Novartis for an investigator-initiated study (2020). The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Outcomes in different time periods of adult patients with hematologic malignancy who underwent first allo-SCT with a transplant from a matched family donor. The periods were separated into decades (A,C-D), and NRM was separated into 5-year periods (B). NRM (A-B), overall survival (C), and progression-free survival (D).
Figure 2.
Figure 2.
Matched-pairs analyses of mortality in patients after allo-SCTs performed from 1990 through 1999 vs those performed from 2013 through 2016. NRM (A), overall survival (B), and progression-free survival (C).
See this image and copyright information in PMC

References

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