Significant Improvement In Overall Survival In Patients Who Underwent Autologous Hematopoietic Cell Transplant In the US or Canada Between 1994 and 2005
Authors: McCarthy Philip L. , Hahn Theresa , Hassebroek Anna , Klein John P. , Rizzo J. Douglas , Parsons Susan , Joffe Steven , Majhail Navneet S. 
Published: October 2019

Abstract 2389

Autologous hematopoietic cell transplantation (autoHCT) is standard therapy for high-risk hematologic disorders and solid tumors. We assessed whether overall survival (OS) at Day 100, which represents early transplant-related mortality (TRM), and at one year, which represents disease-related mortality and later TRM, had changed over time. The study population was derived from patients undergoing 68,404 first autoHCTs between 1994–2005 in US and Canadian centers reported to the CIBMTR. Statistical significance was measured using Ptrend over 6 time cohorts to test whether the OS estimates were stable (slope = 0), increasing (slope>0) or decreasing (slope<0) over time. The Day 100 and 1-year OS estimates are shown in the Table. Disease and disease status subgroups were defined a priori, and the OS estimates are not adjusted for any covariates such as age, Karnofsky status, etc. Mortality rates at Day 100 were, in general, low for all diseases examined and improved significantly over time for NHL in complete remission (CR) 2/sensitive 1st relapse, for lymphoma in primary induction failure (no prior complete remission) and myeloma in first partial or complete remission. Improvements in 1-year OS were seen for NHL in CR1/sensitive 1st relapse and myeloma in remission at the time of transplant. OS has improved for many patients undergoing autoHCT which likely reflects improvement in supportive care and better patient selection. Day 100 mortality rates in autoHCT patients treated during the most recent period 2004-5 are as low as 2–5% in patients with chemotherapy sensitive disease pre-autoHCT. Even in patients transplanted with resistant disease (no prior CR), the Day 100 mortality rate is only 5% in MM and 9% in HL/NHL patients. Although the 1-year OS has improved over time there is still a significant decline in OS between the Day 100 and 1-year time points, especially for patients with NHL in CR2/sensitive 1st relapse, lymphoma in primary induction failure and myeloma not in remission, suggesting a need for improved disease control in these patients.

Table 1: Overall survival (95% CI) estimates over time. Autologous HCT 1994-5 1996-7 1998-9 2000-01 2002-3 2004-5 Ptrend NHL in CR2/Rel 1 sens N 890 1067 1041 1020 946 1116 <0.001 @100 days 89 (87–91) 90 (88–92) 90 (88–92) 94 (92–95) 94 (92–95) 95 (94–97) <0.001 @1 year 68 (65–71) 69 (66–72) 72 (69–75) 77 (75–80) 78 (75–80) 80 (77–83) HL in CR2/Rel1 sens N 384 384 466 435 477 573 0.4758 @100 days 95 (92–97) 95 (92–97) 96 (94–97) 97 (95–98) 96 (94–98) 97 (95–98) 0.1985 @1 year 86 (82–89) 87 (84–91) 87 (83–90) 89 (85–92) 90 (87–93) 91 (88–93) HL or NHL in PIF N 647 708 772 895 570 504 0.0299 @100 days 86 (84–89) 88 (86–90) 87 (84–89) 90 (87–92) 90 (88–93) 91 (89–94) 0.7532 @1 year 69 (65–73) 69 (65–72) 70 (67–74) 72 (68–75) 71 (67–75) 72 (67–76) MM in CR1/PR1/PIF sens N 267 541 718 1567 2423 3192 <0.001 @100 days 96 (94–98) 96 (94–98) 96 (94–97) 97 (96–98) 98 (97–98) 98 (98–99) <0.001 @1 year 83 (79–88) 84 (81–87) 87 (85–90) 90 (89–92) 92 (91–93) 92 (91–93) MM in less than PR N 105 177 392 420 521 586 0.3829 @100 days 92 (85–96) 94 (90–97) 96 (94–98) 96 (94–98) 97 (95–98) 95 (93–97) 0.0857 @1 year 79 (70–87) 79 (73–85) 86 (82–89) 88 (84–91) 88 (85–91) 87 (84–90)

NHL – non-Hodgkin lymphoma, HL – Hodgkin lymphoma, MM – myeloma, CR – complete remission, Rel – relapse, PIF – primary induction failure, sens – sensitive

Disclosures:

No relevant conflicts of interest to declare.