Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era

Navneet S. Majhail, Pintip Chitphakdithai, Brent Logan, Roberta King, Steven Devine, Susan N. Rossmann, Gregory Hale, Robert J. Hartzman, Chatchada Karanes, Ginna G. Laport, Eneida Nemecek, Edward L. Snyder, Galen E. Switzer, John Miller, Willis Navarro, Dennis L. Confer, John E. Levine

Research output: Contribution to journalArticle

40 Scopus citations

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

Original languageEnglish (US)
Pages (from-to)142-150
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2015

Keywords

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

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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  • Cite this

    Majhail, N. S., Chitphakdithai, P., Logan, B., King, R., Devine, S., Rossmann, S. N., Hale, G., Hartzman, R. J., Karanes, C., Laport, G. G., Nemecek, E., Snyder, E. L., Switzer, G. E., Miller, J., Navarro, W., Confer, D. L., & Levine, J. E. (2015). Significant Improvement in Survival after Unrelated Donor Hematopoietic Cell Transplantation in the Recent Era. Biology of Blood and Marrow Transplantation, 21(1), 142-150. https://doi.org/10.1016/j.bbmt.2014.10.001