Continuous reduced nonrelapse mortality after allogeneic hematopoietic stem cell transplantation: a single-institution's three decade experience.
This study analyzed changes in patients, transplantation, graft characteristics, and outcome among 827 patients who received their first allo-SCT in a single center between 1983 and 2010. In the 2001 to 2010 decade, compared with the 1983 to 1990 and 1991 to 2000 decades, patients were significantly older and presented with higher risk diseases, reduced intensity conditioning and alternative donors were used more often, and stem cell sources changed from bone marrow to peripheral blood stem cells and cord blood. In the 2001 to 2010 decade, we observed a significant decrease in nonrelapse mortality (NRM) (P = .0007 and P < .0001, respectively) and an increase in relapse incidence (P = .04 and P = .009, respectively), but overall survival (OS) was increased (P = .11 and P = .009, respectively), and there was a trend towards an increased progression-free survival (P = .30 and P = .09, respectively), as compared with the 1983 to 1990 and 1991 to 2000 decades. Chronic graft-versus-host disease (GVHD) was significantly increased, whereas grades III to IV acute GVHD remained stable. These data suggest that, despite the fact that older and higher risk patients with more comorbidities underwent transplantation in the last 10 years, NRM decreased while the incidence of relapse increased and the OS improved.
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France; CRNCA UMR 892 INSERM -6299 CNRS, Nantes, France.
Florent
F
Malard
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
Patrice
P
Chevallier
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
Thierry
T
Guillaume
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
Jacques
J
Delaunay
Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, France.
Fanny
F
Rialland
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France; Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Jean-Luc
JL
Harousseau
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France; Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Philippe
P
Moreau
Service d'Onco-Hématologie Pédiatrique, CHU de Nantes, France.
Francoise
F
Mechinaud
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
Noel
N
Milpied
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France. Electronic address: Mohamad.mohty@inserm.fr.
Mohamad
M
Mohty
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000401:mortality; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000401:mortality; D055815:Young Adult
Allogeneic stem cell transplantation; Nonrelapse mortality; Overall survival