TY - JOUR
T1 - Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL
T2 - a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT)
AU - Schetelig, Johannes
AU - de Wreede, Liesbeth C.
AU - Andersen, Niels S.
AU - Moreno, Carol
AU - van Gelder, Michel
AU - Vitek, Antonin
AU - Karas, Michal
AU - Michallet, Mauricette
AU - Machaczka, Maciej
AU - Gramatzki, Martin
AU - Beelen, Dietrich
AU - Finke, Jurgen
AU - Delgado, Julio
AU - Volin, Liisa
AU - Passweg, Jakob
AU - Dreger, Peter
AU - Schaap, Nicolaas
AU - Wagner, Eva
AU - Henseler, Anja
AU - van Biezen, Anja
AU - Bornhaeuser, Martin
AU - Iacobelli, Simona
AU - Putter, Hein
AU - Schoenland, Stefan O.
AU - Kroger, Nicolaus
AU - CLL Subcomm
AU - Chronic Malignancies Working Party
PY - 2017/8
Y1 - 2017/8
N2 - The best approach for allogeneic haematopoietic stem cell transplantations (alloHCT) in patients with chronic lymphocytic leukaemia (CLL) is unknown. We therefore analysed the impact of procedure- and centre-related factors on 5-year event-free survival (EFS) in a large retrospective study. Data of 684 CLL patients who received a first alloHCT between 2000 and 2011 were analysed by multivariable Cox proportional hazards models with a frailty component to investigate unexplained centre heterogeneity. Five-year EFS of the whole cohort was 37% (95% confidence interval [CI], 34-42%). Larger numbers of CLL alloHCTs (hazard ratio [HR] 0.96, P = 0.002), certification of quality management (HR 0.7, P = 0.045) and a higher gross national income per capita (HR 0.4, P = 0.04) improved EFS. In vivo T-cell depletion (TCD) with alemtuzumab compared to no TCD (HR 1.5, P = 0.03), and a female donor compared to a male donor for a male patient (HR 1.4, P = 0.02) had a negative impact on EFS, but not non-myeloablative versus more intensive conditioning. After correcting for patient-, procedure- and centre-characteristics, significant variation in centre outcomes persisted. In conclusion, further research on the impact of centre and procedural characteristics is warranted. Non-myeloablative conditioning appears to be the preferable approach for patients with CLL.
AB - The best approach for allogeneic haematopoietic stem cell transplantations (alloHCT) in patients with chronic lymphocytic leukaemia (CLL) is unknown. We therefore analysed the impact of procedure- and centre-related factors on 5-year event-free survival (EFS) in a large retrospective study. Data of 684 CLL patients who received a first alloHCT between 2000 and 2011 were analysed by multivariable Cox proportional hazards models with a frailty component to investigate unexplained centre heterogeneity. Five-year EFS of the whole cohort was 37% (95% confidence interval [CI], 34-42%). Larger numbers of CLL alloHCTs (hazard ratio [HR] 0.96, P = 0.002), certification of quality management (HR 0.7, P = 0.045) and a higher gross national income per capita (HR 0.4, P = 0.04) improved EFS. In vivo T-cell depletion (TCD) with alemtuzumab compared to no TCD (HR 1.5, P = 0.03), and a female donor compared to a male donor for a male patient (HR 1.4, P = 0.02) had a negative impact on EFS, but not non-myeloablative versus more intensive conditioning. After correcting for patient-, procedure- and centre-characteristics, significant variation in centre outcomes persisted. In conclusion, further research on the impact of centre and procedural characteristics is warranted. Non-myeloablative conditioning appears to be the preferable approach for patients with CLL.
KW - chronic lymphocytic leukaemia
KW - allogeneic stem cell transplantation
KW - risk factor analysis
KW - centre effects
KW - frailties
KW - CHRONIC LYMPHOCYTIC-LEUKEMIA
KW - STEM-CELL TRANSPLANTATION
KW - QUALITY MANAGEMENT-SYSTEM
KW - IBRUTINIB
KW - GUIDELINES
KW - SURVIVAL
KW - ALEMTUZUMAB
KW - DIAGNOSIS
KW - RESPONSES
KW - ABT-199
U2 - 10.1111/bjh.14791
DO - 10.1111/bjh.14791
M3 - Article
C2 - 28589551
SN - 0007-1048
VL - 178
SP - 521
EP - 533
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 4
ER -