Journal
JOURNAL OF CLINICAL ONCOLOGY
Volume 31, Issue 19, Pages 2437-2449Publisher
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.2012.46.6193
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Funding
- National Cancer Institute (NCI), National Heart, Lung, and Blood Institute (NHLBI) [U24-CA76518]
- National Institute of Allergy and Infectious Diseases
- NHLBI [5U01HL069294]
- NCI
- Health Resources and Services Administration [HHSH234200637015C]
- Office of Naval Research [N00014-06-1-0704, N00014-08-1-0058]
- Allos
- Amgen
- Angioblast
- Ariad
- Be the Match Foundation
- BlueCross BlueShield Association
- Buchanan Family Foundation
- CaridianBCT
- Celgene
- Celgene, CellGenix
- Children's Leukemia Research Association
- Fresenius-Biotech North America
- Gamida Cell Teva Joint Venture
- Genentech
- Genzyme
- GlaxoSmithKline
- HistoGenetics
- Kiadis Pharma
- Leukemia and Lymphoma Society
- Medical College of Wisconsin
- Merck
- Millennium Pharmaceuticals
- Takeda Oncology
- Milliman USA
- Miltenyi Biotec
- National Marrow Donor Program
- Optum Healthcare Solutions
- Osiris Therapeutics
- Otsuka America Pharmaceutical
- Remedy MD
- sanofi-aventis
- Seattle Genetics
- Sigma-Tau Pharmaceuticals
- Soligenix
- StemCyte
- Stemsoft Software
- Swedish Orphan Biovitrum
- Tarix Pharmaceuticals
- Teva Neuroscience
- THERAKOS
- Wellpoint
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Purpose Over the past four decades, allogeneic hematopoietic cell transplantation (alloHCT) has evolved as a curative modality for patients with hematologic diseases. This study describes changes in use, technique, and survival in a population-based cohort. Patients and Methods The study included 38,060 patients with hematologic malignancies or disorders who underwent first alloHCT in a US or Canadian center from 1994 to 2005 and were reported to the Center for International Blood and Marrow Transplant Research. Results AlloHCT as treatment for acute lymphoblastic (ALL) and myeloid leukemias (AML), myelodysplastic syndrome (MDS), and Hodgkin and non-Hodgkin lymphomas increased by 45%, from 2,520 to 3,668 patients annually. From 1994 to 2005, use of both peripheral (7% to 6%) and cord blood increased (2% to 10%), whereas use of marrow decreased (90% to 27%). Despite a median age increase from 33 to 40 years and % increase in unrelated donors for alloHCT, overall survival (OS) at day 100 significantly improved for patients with AML in first complete remission after myeloablative sibling alloHCT (85% to 94%; P < .001) and unrelated alloHCT (63% to 86%; P < .001); 1-year OS improved among those undergoing unrelated alloHCT (48% to 63%; P = .003) but not among those undergoing sibling alloHCT. Similar results were seen for ALL and MDS. Day-100 OS after cord blood alloHCT improved significantly from 60% to 78% (P < .001) for AML, ALL, MDS, and chronic myeloid leukemia. Use of reduced-intensity regimens increased, yielding OS rates similar to those of myeloablative regimens. Conclusion Survival for those undergoing alloHCT has significantly improved over time. However, new approaches are needed to further improve 1-year OS.
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