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Scientific article
English

Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT)

CollaboratorsChalandon, Yves
Published inBritish journal of haematology, vol. 178, no. 4, p. 521-533
Publication date2017-08
First online date2017-06-07
Abstract

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.

eng
Keywords
  • Allogeneic stem cell transplantation
  • Centre effects
  • Chronic lymphocytic leukaemia
  • Frailties
  • Risk factor analysis
  • Adult
  • Aged
  • Delivery of Health Care / statistics & numerical data
  • Europe / epidemiology
  • Female
  • Hematopoietic Stem Cell Transplantation / methods
  • Humans
  • Kaplan-Meier Estimate
  • Karnofsky Performance Status
  • Leukemia, Lymphocytic, Chronic, B-Cell / mortality
  • Leukemia, Lymphocytic, Chronic, B-Cell / therapy
  • Male
  • Middle Aged
  • Professional Practice / statistics & numerical data
  • Recurrence
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Transplantation Conditioning / methods
Citation (ISO format)
SCHETELIG, Johannes et al. Centre characteristics and procedure-related factors have an impact on outcomes of allogeneic transplantation for patients with CLL: a retrospective analysis from the European Society for Blood and Marrow Transplantation (EBMT). In: British journal of haematology, 2017, vol. 178, n° 4, p. 521–533. doi: 10.1111/bjh.14791
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Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal0007-1048
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