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Transplant center characteristics and survival after allogeneic hematopoietic cell transplantation in adults

Bone Marrow Transplantation volume 55, pages 906–917 (2020)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) is a highly specialized procedure. We surveyed adult transplant centers in the United States (US) and then used data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) (2008–2010) to evaluate associations of center volume, infrastructure, and care delivery models with survival post alloHCT. Based on their 2010 alloHCT volume, centers were categorized as low-volume (≤40 alloHCTs; N = 42 centers, 1900 recipients) or high-volume (>40 alloHCTs; N = 41 centers, 9637 recipients). 100-day survival was 86% (95% CI, 85–87%) in high-volume compared with 83% (95% CI, 81–85%) in low-volume centers (difference 3%; P < 0.001). One-year survival was 62% (95% CI, 61–63%) and 56% (95% CI, 54–58%), respectively (difference 6%; P < 0.001). Logistic regression analyses adjusted for patient and center characteristics; alloHCT at high-volume centers (odds ratio [OR] 1.32; P < 0.001) and presence of a survivorship program dedicated to HCT recipients (OR 1.23; P = 0.009) were associated with favorable 1-year survival compared to low-volume centers. Similar findings were observed in a CIBMTR validation cohort (2012–2014); high-volume centers had better 1-year survival (OR 1.24, P < 0.001). Among US adult transplant centers, alloHCT at high-volume centers and at centers with survivorship programs is associated with higher 1-year survival.

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Acknowledgements

We sincerely thank all transplant center Medical Directors who completed the survey. We would like to acknowledge the National Marrow Donor Program’s System Capacity Initiative Program for providing funds for the survey incentive and for providing staff support for implementing and analyzing the survey. We sincerely appreciate review of our manuscript draft and constructive feedback provided by Mary Horowitz, MD, MS, Center for International Blood and Marrow Transplant Research, Milwaukee, and Linda Burns, MD, Center for International Blood and Marrow Transplant Research and National Marrow Donor Program, Minneapolis.

Funding

The Center for International Blood and Marrow Transplant Research (CIBMTR) is supported by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10-HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research; and grants from Alexion; *Amgen, Inc.; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; AstraZeneca; Be the Match Foundation; *Bluebird Bio, Inc.; *Bristol Myers Squibb Oncology; *Celgene Corporation; Cellular Dynamics International, Inc.; *Chimerix, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Genentech, Inc.; Genzyme Corporation; *Gilead Sciences, Inc.; Health Research, Inc. Roswell Park Cancer Institute; HistoGenetics, Inc.; Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Jeff Gordon Children’s Foundation; The Leukemia & Lymphoma Society; Medac, GmbH; MedImmune; The Medical College of Wisconsin; *Merck & Co, Inc.; Mesoblast; MesoScale Diagnostics, Inc.; *Miltenyi Biotec, Inc.; National Marrow Donor Program; Neovii Biotech NA, Inc.; Novartis Pharmaceuticals Corporation; Onyx Pharmaceuticals; Optum Healthcare Solutions, Inc.; Otsuka America Pharmaceutical, Inc.; Otsuka Pharmaceutical Co, Ltd. - Japan; PCORI; PerkinElmer, Inc.; Pfizer, Inc; *Sanofi US; *Seattle Genetics; *Spectrum Pharmaceuticals, Inc.; St. Baldrick’s Foundation; *Sunesis Pharmaceuticals, Inc.; Swedish Orphan Biovitrum, Inc.; Takeda Oncology; Telomere Diagnostics, Inc.; University of Minnesota; and *Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration (HRSA) or any other agency of the U.S. Government (*Corporate Members).

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Authors and Affiliations

  1. Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, OH, USA

    Navneet S. Majhail

  2. National Marrow Donor Program, Minneapolis, MN, USA

    Lih-Wen Mau, Ellen M. Denzen, Pam Robinett & Elizabeth Murphy

  3. Center for International Blood and Marrow Transplant Research, Minneapolis, MN, USA

    Pintip Chitphakdithai

  4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Steven Joffe

  5. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Stephanie J. Lee

  6. Sarah Cannon, Nashville, TN, USA

    Charles F. LeMaistre

  7. Pfizer Oncology, Omaha, NE, USA

    Fausto Loberiza

  8. Center for Health Solutions, Tufts Medical Center, Boston, MA, USA

    Susan K. Parsons

  9. Blood and Marrow Transplant Program, Moffitt Cancer Center, Tampa, FL, USA

    Ramona Repaczki-Jones

  10. Center for International Blood and Marrow Transplant Research, Milwaukee, WI, USA

    J. Douglas Rizzo & Brent Logan

  11. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Jennifer Le-Rademacher

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  1. Navneet S. Majhail
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  12. J. Douglas Rizzo
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  13. Elizabeth Murphy
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  15. Jennifer Le-Rademacher
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Contributions

Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of manuscript: NSM, L-WM, JL-R. Critical revision of manuscript for important intellectual content: All authors. Statistical analysis: L-WM, PC, JL-R, BL. Administrative, technical or material support: NSM, L-WM, EMD. Study supervision: NSM.

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Correspondence to Navneet S. Majhail.

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Fausto Loberiza was affiliated with the University of Nebraska, Omaha, NE and Ramona Repaczki-Jones was affiliated with the Foundation for the Accreditation of Cellular Therapy, Omaha, NE during the conduct of this study.

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Majhail, N.S., Mau, LW., Chitphakdithai, P. et al. Transplant center characteristics and survival after allogeneic hematopoietic cell transplantation in adults. Bone Marrow Transplant 55, 906–917 (2020). https://doi.org/10.1038/s41409-019-0748-1

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