title: Improved survival after allogeneic hematopoietic stem cell transplantation in recent years. A single-center study.
abstract: We analyzed the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) over the past 2 decades. Between 1992 and 2009, 953 patients were treated with HSCT, mainly for a hematologic malignancy. They were divided according to 4 different time periods of treatment: 1992 to 1995, 1996 to 2000, 2001 to 2005, and 2006 to 2009. Over the years, many factors have changed considerably regarding patient age, diagnosis, disease stage, type of donor, stem cell source, genomic HLA typing, cell dose, type of conditioning, treatment of infections, use of granulocyte-colony stimulating factor (G-CSF), use of mesenchymal stem cells, use of cytotoxic T cells, and home care. When we compared the last period (2006-2009) with earlier periods, we found slower neutrophil engraftment, a higher incidence of acute graft-versus-host disease (aGVHD) of grades II-IV, and less chronic GVHD (cGHVD). The incidence of relapse was unchanged over the 4 periods (22%-25%). Overall survival (OS) and transplant-related mortality (TRM) improved significantly in the more recent periods, with the best results during the last period (2006-2009) and a 100-day TRM of 5.5%. This improvement was also apparent in a multivariate analysis. When correcting for differences between the 4 groups, the hazard ratio for mortality in the last period was 0.59 (95% confidence interval [CI]: 0.44-0.79; P < .001) and for TRM it was 0.63 (CI: 0.43-0.92; P = .02). This study shows that the combined efforts to improve outcome after HSCT have been very effective. Even though we now treat older patients with more advanced disease and use more alternative HLA nonidentical donors, OS and TRM have improved. The problem of relapse still has to be remedied. Thus, several different developments together have resulted in significantly lower TRM and improved survival after HSCT over the last few years.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden. mats.remberger@ki.se
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.forename: Malin
authors.initials: M
authors.lastname: Ackefors
authors.forename: Sofia
authors.initials: S
authors.lastname: Berglund
authors.forename: Ola
authors.initials: O
authors.lastname: Blennow
authors.forename: Göran
authors.initials: G
authors.lastname: Dahllöf
authors.forename: Aldona
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authors.lastname: Dlugosz
authors.forename: Karin
authors.initials: K
authors.lastname: Garming-Legert
authors.forename: Jens
authors.initials: J
authors.lastname: Gertow
authors.forename: Britt
authors.initials: B
authors.lastname: Gustafsson
authors.forename: Moustapha
authors.initials: M
authors.lastname: Hassan
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Hassan
authors.forename: Dan
authors.initials: D
authors.lastname: Hauzenberger
authors.forename: Hans
authors.initials: H
authors.lastname: Hägglund
authors.forename: Helen
authors.initials: H
authors.lastname: Karlsson
authors.forename: Lena
authors.initials: L
authors.lastname: Klingspor
authors.forename: Gunilla
authors.initials: G
authors.lastname: Kumlien
authors.forename: Katarina
authors.initials: K
authors.lastname: Le Blanc
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Maciej
authors.initials: M
authors.lastname: Machaczka
authors.forename: Karl-Johan
authors.initials: KJ
authors.lastname: Malmberg
authors.forename: Hanns-Ulrich
authors.initials: HU
authors.lastname: Marschall
authors.forename: Jonas
authors.initials: J
authors.lastname: Mattsson
authors.forename: Richard
authors.initials: R
authors.lastname: Olsson
authors.forename: Brigitta
authors.initials: B
authors.lastname: Omazic
authors.forename: Darius
authors.initials: D
authors.lastname: Sairafi
authors.forename: Marie
authors.initials: M
authors.lastname: Schaffer
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Svahn
authors.forename: Petter
authors.initials: P
authors.lastname: Svenberg
authors.forename: Lisa
authors.initials: L
authors.lastname: Swartling
authors.forename: Attila
authors.initials: A
authors.lastname: Szakos
authors.forename: Michael
authors.initials: M
authors.lastname: Uhlin
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uzunel
authors.forename: Emma
authors.initials: E
authors.lastname: Watz
authors.forename: Annika
authors.initials: A
authors.lastname: Wernerson
authors.forename: Agneta
authors.initials: A
authors.lastname: Wikman
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Wikström
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult