Significant Improvement In Day 100 and 1-Year Overall Survival In Patients Who Underwent Myeloablative Allogeneic Hematopoietic Cell Transplant In the US or Canada Between 1994 and 2005
Authors: Hahn Theresa , McCarthy Philip L. , Hassebroek Anna , Klein John P. , Rizzo J. Douglas , Parsons Susan , Joffe Steven , Majhail Navneet S. 
Published: October 2019

Abstract 3509

Allogeneic hematopoietic cell transplantation (alloHCT) has become standard therapy for hematologic disorders and malignancies. We assessed whether overall survival (OS) at 100 days, 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 38,060 first alloHCTs between 1994–2005 in US and Canadian centers and reported to the CIBMTR. Donor lymphocyte infusions were excluded. 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. Marked improvements in 100-day survival were seen for all disease and disease status groups examined. Day 100 mortality rates in HLA-matched sibling alloHCT recipients during the most recent period (2004-5) were as low as 2% for CML treated in CP1, 6–8% for AML in CR1 and ALL in CR2, and a modest 12% for MDS. Even in alloHCT recipients with unrelated donors treated in 2004-5, the Day 100 mortality rates ranged from 9–22%, a significant decrease from historical mortality rates of 29–37%. Significant improvements in 1-year OS were noted for all groups undergoing unrelated-donor alloHCT; however, among those undergoing HLA-matched sibling alloHCT, significant improvements in 1-year OS were only seen in patients with CML in CP1 or MDS. OS has improved for many patients undergoing myeloablative alloHCT, which likely reflects improvement in supportive care and better patient/donor selection. Day 100 OS has significantly improved in all patients who received a myeloablative HLA-matched related or unrelated donor alloHCT. Significant improvement in 1-year OS was also experienced by most patients.

Table: Overall survival (95% CI) estimates over time HLA-Matched Sibling Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 370 370 383 376 384 440 <0.001     @100 days 85 (81–88) 87 (84–90) 90 (86–93) 88 (84–91) 92 (89–94) 94 (91–96) 0.1662     @1 year 69 (65–74) 70 (66–75) 72 (67–76) 67 (62–72) 74 (69–78) 75 (71–80) ALL in CR2+     N 179 186 149 159 156 163 0.0018     @100 days 77 (70–83) 82 (76–87) 88 (82–93) 85 (79–90) 85 (79–90) 92 (87–96) 0.2937     @1 year 62 (55–69) 63 (56–70) 69 (61–77) 59 (51–67) 64 (56–71) 70 (62–77) CML in CP1     N 483 540 492 317 155 125 <0.001     @100 days 84 (81–87) 88 (85–90) 89 (87–92) 91 (87–94) 99 (96–100) 98 (94–100) <0.001     @1 year 71 (66–75) 72 (68–76) 80 (76–83) 82 (77–86) 89 (83–93) 92 (86–96) MDS     N 225 290 273 235 239 227 <0.001     @100 days 71 (65–77) 75 (70–80) 76 (71–81) 82 (77–87) 85 (80–89) 88 (84–92) 0.0488     @1 year 54 (48–61) 51 (45–57) 57 (51–63) 58 (51–65) 61 (55–68) 64 (58–71) Unrelated Donor Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 52 75 88 135 182 336 <0.001     @100 days 63 (50–76) 64 (53–74) 69 (59–78) 75 (68–82) 82 (76–87) 86 (82–90) 0.0427     @1 year 48 (35–62) 35 (25–47) 48 (37–59) 51 (42–60) 54 (46–61) 56 (50–62) ALL in CR2+     N 129 151 132 116 164 197 <0.001     @100 days 66 (58–74) 70 (62–77) 71 (62–78) 75 (67–82) 78 (71–84) 91 (87–95) <0.001     @1 year 43 (34–51) 45 (37–53) 49 (40–58) 40 (31–50) 54 (46–62) 67 (60–74) CML in CP1     N 211 250 292 152 87 118 0.0006     @100 days 71 (65–77) 70 (64–75) 74 (69–79) 75 (68–81) 80 (71–88) 87 (81–93) 0.0057     @1 year 51 (44–57) 54 (48–61) 59 (53–64) 60 (52–68) 65 (54–75) 71 (62–80) MDS     N 104 138 135 140 161 234 <0.001     @100 days 64 (54–73) 62 (54–70) 59 (51–67) 67 (59–75) 74 (67–81) 78 (72–83) <0.001     @1 year 41 (31–50) 44 (35–52) 35 (27–43) 45 (37–54) 52 (44–60) 57 (50–63)

Disclosures:

No relevant conflicts of interest to declare.