Longitudinal Survival Outcomes in Allogeneic Stem Cell Transplantation: An Institutional Experience

Area of Science:

• Hematology
• Transplantation Immunology

Background:

• Allogeneic hematopoietic stem cell transplantation (allo-SCT) offers a curative potential for hematological disorders.
• Complications such as disease relapse, graft-versus-host disease (GVHD), and infections can impact allo-SCT outcomes.
• Longitudinal analysis is crucial to assess the impact of therapeutic advancements on survival post-transplant.

Purpose of the Study:

• To evaluate longitudinal changes in survival outcomes following allo-SCT.
• To assess the impact of therapeutic advancements on mitigating transplant complications.
• To analyze trends in overall survival (OS), progression-free survival (PFS), and GVHD-free relapse-free survival (GRFS) over time.

Main Methods:

• Retrospective analysis of 1943 patients undergoing allo-SCT between 1984 and 2018.
• Patients grouped by transplant year to analyze survival trends.
• Primary endpoints: OS, PFS, GRFS. Secondary endpoints: acute GVHD (aGVHD), chronic GVHD (cGVHD), non-relapse mortality (NRM).

Main Results:

• Statistically significant improvements observed in OS, PFS, and GRFS over the study period.
• Five-year PFS increased from 24% to 48%; five-year OS increased from 25% to 53%.
• While GRFS improved significantly, its rate plateaued from 2004-2018; NRM decreased since 2004, but aGVHD incidence increased since 2009.

Conclusions:

• Allo-SCT outcomes, including OS, PFS, and GRFS, have demonstrably improved over recent decades.
• These improvements are likely attributable to advancements in supportive care and targeted therapies for GVHD and relapse.
• Continued research into mitigating transplant-related complications remains essential for further enhancing patient survival and quality of life.