Among patients undergoing allogeneic stem cell transplantation (allo-SCT), nonrelapse mortality has drastically decreased over the past 4 decades, according to research published in Blood Advances.
Since the initiation of allo-SCT for hematological diseases approximately 40 years ago, the procedure has become commonplace, with roughly 20,000 annual transplantations noted in the European Society for Blood and Marrow Transplantation (EBMT) registry. While this treatment can be curative in a range of disease settings, it also carries significant risks, including acute or chronic graft-vs-host-disease (GVHD), infection, and toxicity related to transplantation conditioning, each of which contributes to patient risk of nonrelapse mortality.
There is some evidence that nonrelapse mortality risk has dropped since allo-SCT treatment entered use. For this retrospective, multicenter analysis, researchers reviewed data from the EBMT registry to determine any changes in nonrelapse mortality rates from 1980 through 2016. Data from 38,800 patients were included and were divided into 4 cohorts: 1980 to 1989, 1990 to 1999, 2000 to 2009, and 2010 to 2016. The most common patient diagnosis was acute myeloid leukemia in all 4 cohorts.
Over the study period, transplantation characteristics changed drastically. Donor cell source was almost uniformly bone marrow in the 1980 to 1989 cohort (99.9%), and dropped to 12.1% in the 2010 to 2016 cohort, with peripheral blood making up the remaining 87.9%. The median patient age also increased from 29.2 years in 1980 to 1989 to 49.5 years in 2010 to 2016.
The rate of 1-year nonrelapse mortality decreased from 29.7% among patients in the 1980 to 1989 cohort to 12.2% among patients in the 2010 to 2016 cohort. Multivariate analysis showed that the period in which transplantation took place was associated with nonrelapse mortality risk (hazard ratio [HR] for 5-year intervals, 0.8; P <.0001) and reduced mortality risk overall (HR, 0.87; P <.0001).
A matched-paired analysis showed that 1-year nonrelapse mortality in the 1990s compared with the period from 2013 to 2016 was 24.4% vs 9.5%, respectively (HR, 0.39; P <.0001).
“Taken together, the results of our analyses showed that [nonrelapse mortality] has decreased significantly over time,” the authors wrote. “Advances in intensive care medicine and treatments of infectious disease and GVHD and reductions in the intensity of conditioning regimens are the likely contributors to better outcomes after allo-SCT.”
Disclosure: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Penack O, Peczynski C, Mohty M, et al. How much has allogeneic stem cell transplant-related mortality improved since the 1980s? a retrospective analysis from the EBMT. Blood Adv. 2020;4(24):6283-90. doi:10.1182/bloodadvances.2020003418