NEW YORK (Reuters Health) – Since the mid-90s, early survival rates after allogeneic hematopoietic cell transplantation (alloHCT) among patients with hematologic diseases have improved significantly, based on an analysis of registry data.

However, “Additional improvements in later (1 year) OS (overall survival) are still needed,” according to the report.

The authors of the study in the May 28 online issue of the Journal of Clinical Oncology analyzed changes in the use and outcome of allogeneic HCT for the treatment of malignancies and nonmalignant disorders, using data compiled by the Center for International Blood and Marrow Transplant Research.

The analysis included some 38,000 patients treated between 1994 and 2005. The 12-year timeframe was divided into six 2-year periods in order to examine trends over time.

Dr. Navneet S. Majhail, with the National Marrow Donor Program in Minneapolis, Minnesota, and colleagues found that the use of marrow as a source of hematopoietic cells decreased substantially during the study period from 90% to 27%, while the use of peripheral blood increased (7% to 65%), as did the use of umbilical cord blood (2% to 10%).

Median recipient age increased form 33 to 40 years, and the proportion of transplants from unrelated donors rose from 24% to 45%. Despite those two trends, overall survival at day 100 post transplant improved for patients with acute myeloid leukemia, acute lymphoblastic leukemia and myelodysplastic syndrome, the researchers found.

For patients with AML in first remission, for example, 100-day survival increased significantly from 84% to 94% with HCT from a sibling donor and from 63% to 86% with an unrelated donor (both p<0.001), according to the report.

However, 1-year survival did not improve significantly for those undergoing sibling HCT (69% to 75%; p=0.166), although there was improvement for unrelated HCT (48% to 63%; p=0.003).

Dr. Majhail and colleagues attribute the increase in early survival to a number of factors. “We postulate that the significant improvements in OS over this time period have resulted from advancements in high-resolution HLA typing, improvements in supportive care after alloHCT, better patient selection, better understanding of patient and disease prognostic factors, and earlier referral for transplantation.”

Still, they add, the focus now must be on improving longer-term survival. “Additional advancements to reduce the burden of GVHD and disease relapse after alloHCT are priority research areas,” they conclude.

SOURCE: Significant Improvement in Survival After Allogeneic Hematopoietic Cell Transplantation During a Period of Significantly Increased Use, Older Recipient Age, and Use of Unrelated Donors
J Clin Oncol 2013;31.