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Biol Blood Marrow Transplant. 2015 Jan;21(1):142-50. doi: 10.1016/j.bbmt.2014.10.001. Epub 2014 Oct 15.

Significant improvement in survival after unrelated donor hematopoietic cell transplantation in the recent era.

Author information

1
Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio; National Marrow Donor Program, Minneapolis, Minnesota.
2
National Marrow Donor Program, Minneapolis, Minnesota.
3
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
4
Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
5
Gulf Coast Regional Blood Center, Houston, Texas.
6
Pediatric Hematology, Oncology and BMT, All Children's Hospital, St Petersburg, Florida.
7
Naval Medical Research Center, Rockville, Maryland.
8
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
9
Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
10
Pediatric Blood and Marrow Transplant Program, Oregon Health Science University, Portland, Oregon.
11
Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.
12
Departments of Medicine and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
13
Division of Pediatric Hematology/Oncology, University of Michigan Medical Center, Ann Arbor, Michigan. Electronic address: jelevine@umich.edu.

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 <18 years with malignant diseases (n = 1920), ages 18 to 59 years with malignant diseases (n = 9575), ages ≥ 60 years 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 (<18 years: 55% versus 45%, 18 to 59 years: 42% versus 35%, ≥ 60 years: 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.

KEYWORDS:

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

PMID:
25445638
PMCID:
PMC4272902
DOI:
10.1016/j.bbmt.2014.10.001
[Indexed for MEDLINE]
Free PMC Article
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