title: Significant improvement in survival after unrelated donor hematopoietic cell transplantation in the recent era.
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.
authors.affiliation: Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio; National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Navneet S
authors.initials: NS
authors.lastname: Majhail
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Pintip
authors.initials: P
authors.lastname: Chitphakdithai
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Brent
authors.initials: B
authors.lastname: Logan
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Roberta
authors.initials: R
authors.lastname: King
authors.affiliation: Blood and Marrow Transplant Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Devine
authors.affiliation: Gulf Coast Regional Blood Center, Houston, Texas.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Rossmann
authors.affiliation: Pediatric Hematology, Oncology and BMT, All Children's Hospital, St Petersburg, Florida.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hale
authors.affiliation: Naval Medical Research Center, Rockville, Maryland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hartzman
authors.affiliation: Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California.
authors.forename: Chatchada
authors.initials: C
authors.lastname: Karanes
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.affiliation: Pediatric Blood and Marrow Transplant Program, Oregon Health Science University, Portland, Oregon.
authors.forename: Eneida
authors.initials: E
authors.lastname: Nemecek
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Snyder
authors.affiliation: Departments of Medicine and Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: John
authors.initials: J
authors.lastname: Miller
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Willis
authors.initials: W
authors.lastname: Navarro
authors.affiliation: National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Confer
authors.affiliation: Division of Pediatric Hematology/Oncology, University of Michigan Medical Center, Ann Arbor, Michigan. Electronic address: jelevine@umich.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D061349:Unrelated Donors
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents
keywords: Hematopoietic cell transplantation; National Marrow Donor Program; Survival; Treatment-related mortality; Unrelated donors