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). (7th June 2017)

• Record Type: Journal Article
• Authors: Schetelig, Johannes; de Wreede, Liesbeth C.; Andersen, Niels S.; Moreno, Carol; van Gelder, Michel; Vitek, Antonin; Karas, Michal; Michallet, Mauricette; Machaczka, Maciej; Gramatzki, Martin; Beelen, Dietrich; Finke, Jürgen; Delgado, Julio; Volin, Liisa; Passweg, Jakob; Dreger, Peter; Schaap, Nicolaas; Wagner, Eva; Henseler, Anja; van Biezen, Anja; Bornhäuser, Martin; Iacobelli, Simona; Putter, Hein; Schönland, Stefan O.; Kröger, Nicolaus
• Other Names: Gramatzki Martin investigator.; Vitek Antonin investigator.; Esteve Jordi investigator.; Ljungman Per investigator.; de Witte Theo investigator.; Stelljes Matthias investigator.; Sierra Jorge investigator.; Kröger Nicolaus investigator.; Socié Gerard investigator.; Ganser Arnold investigator.; Wulf Gerhard G. investigator.; Deconinck Eric investigator.; Faber Edgar investigator.; Feguex Nathalie investigator.; Gedde‐Dahl Tobias investigator.; Kolbe Karin investigator.; Chalandon Yves investigator.; Krüger William investigator.; Huynh Anne investigator.; Bourhis Jean Henri investigator.; Schouten Harry investigator.; Ribera Santasusana Josep M. investigator.
• Is Part Of: British journal of haematology. Volume 178:Number 4(2017)
• Page Start: 521
• Page End: 533
• Publication Date: 2017-06-07
• Subjects: chronic lymphocytic leukaemia -- allogeneic stem cell transplantation -- risk factor analysis -- centre effects -- frailties; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.14791
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: 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.