Long-term results of allogeneic stem cell transplantation in 533 patients: a single centre experience
Authors:
M. Krejčí; M. Doubek; M. Tomíška; Z. Ráčil; A. Janíková; Y. Brychtová; B. Robešová; J. Procházková; A. Žmijáková; K. Kšeňáková; P. Kouřilová; Z. Král; J. Mayer
Authors‘ workplace:
Interní hematologická a onkologická klinika LF MU a FN Brno
Published in:
Transfuze Hematol. dnes,24, 2018, No. 4, p. 284-296.
Category:
Original Papers
Overview
Allogeneic stem cell transplantation (SCT) is considered to be the treatment of choice for many haematological disorders, especially haematological malignancies. We present here our long-term experience with allogeneic SCT in cohort of 533 pts.
We analysed 533 pts who underwent allogeneic SCT at our centre from November 1996 to June 2017. The diagnoses were as follows: AML (187 pts; 35%), ALL (73 pts, 14%), lymphomas (66 pts, 12%), MDS + MPN (52 pts, 10%), CML (74 pts, 14%), CLL (47 pts, 9%), other diagnoses (34 pts, 6%). The median age was 45 years (range 18–64). The types of donors and grafts used were as follows: HLA identical sibling, n = 257 (48%); unrelated donor, n = 276 (52%); PBSCs, n = 492 (92%); BM, n = 41 (8%). Median follow-up from SCT was 26.6 months, median follow-up from SCT for surviving pts was 83.2 months. Myeloablative conditioning (MAC) was used in 253 pts (47%), reduced intensity conditioning (RIC) was used in 280 pts (53%). Disease status at SCT was remission in 351 pts (66%) and active disease in 182 pts (34%). Median time from diagnosis to SCT was 7.4 months.
The overall response rate after allogeneic SCT was 82%, including CR in 78% of pts and PR in 4% of pts. The incidence of acute and chronic GvHD was 42% and 40% resp. Non-relapse mortality (NRM) was 18%, 19% and 20% at 1 year, 2 years and 4 years from SCT resp. Relapse incidence was 22%, 27% and 31% at 1 year, 2 years and 4 years from SCT resp. Median PFS was 31.5 months, median OS was 85.6 months. Gender, type of donor, type of graft, time from diagnosis to SCT and type of conditioning did not significantly influence PFS and OS in our cohort of pts. Patients with AML had significantly shorter PFS compared to pts with other diagnoses (median PFS 18.9 months versus 43.2 months, p = 0.031, HR 1.32). Patients with active disease at SCT had significantly shorter PFS compared to pts in remission at SCT (median PFS 9.6 months versus 73.7 months, p < 0.001, HR 1.79). On multivariate analysis, diagnosis of AML versus other diagnoses (median OS 29.7 months versus 197.2 months, p < 0.001, HR 1.63) and active disease at SCT versus remission at SCT (median OS 25.0 months versus 186.5 months, p < 0.001, HR 1.93) were significant predictors of poor OS.
Allogeneic transplantation remains the standard treatment option predominantly for various haematological malignancies. According to our results, the type of diagnosis and disease status at allogeneic SCT are important prognostic factors for PFS and OS. Patients in remission of their disease at the time of allogeneic SCT have significantly longer PFS and OS.
Key words:
allogeneic stem cell transplantation – haematological malignancies – acute leukaemi
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