Impact of Center Volume on Chronic Graft Versus Host Disease in Patients With Allogeneic Stem Cell Transplantation

Area of Science:

• Hematology
• Transplantation Immunology
• Oncology

Background:

• Chronic graft-versus-host disease (cGVHD) is a serious complication following allogeneic hematopoietic stem cell transplantation (HSCT).
• Management of cGVHD is complex, leading to practice variations despite established guidelines.
• The impact of institutional experience, measured by center volume, on cGVHD incidence and outcomes is not well understood.

Purpose of the Study:

• To investigate the association between hematopoietic stem cell transplantation (HSCT) center volume and the incidence of chronic graft-versus-host disease (cGVHD).
• To evaluate the effect of center volume on overall survival (OS) for patients diagnosed with cGVHD.

Main Methods:

• Retrospective analysis of 28,786 patients undergoing their first HSCT and 7,664 patients who developed cGVHD.
• Institutions were categorized into quartiles (very low, low, high, very high) based on HSCT procedure volume.
• Statistical analysis assessed cGVHD incidence in the overall cohort and OS in the cGVHD cohort, adjusting for relevant factors.

Main Results:

• The very high-volume HSCT center group exhibited a significantly higher incidence of cGVHD (aHR=1.38) compared to the very low-volume group.
• Incidence of cGVHD was comparable across very low-, low-, and high-volume centers.
• Patients with cGVHD treated at low, high, and very high-volume centers demonstrated significantly improved OS compared to those at very low-volume centers.

Conclusions:

• Higher HSCT center volume is associated with an increased incidence of chronic graft-versus-host disease.
• Lower HSCT center volume is linked to poorer survival outcomes for patients who develop cGVHD.
• These findings suggest that institutional experience plays a crucial role in cGVHD management and patient survival post-HSCT.