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Passweg JR, Baldomero H, Ansari M, Arber C, Chalandon Y, Daskalakis M, Diepold M, Diesch-Furlanetto T, Duchosal MA, Gerull S, Güngör T, Heim D, Hitz F, Holbro A, Masouridi-Levrat S, Nair G, Novak U, Pabst T, Renner C, Stussi G, Schneidawind D, Schanz U, Wannesson L, Halter JP. Hematopoietic cell transplantation and cellular therapies in Switzerland. Evolution over 25 years. A report from the stem cell transplantation and cellular therapies working groups of the SBST 1997-2021. Hematol Oncol 2024; 42:e3241. [PMID: 38058031 DOI: 10.1002/hon.3241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023]
Abstract
The Swiss Blood Stem Cell Transplantation and Cellular Therapy Group (SBST) leads a mandatory national registry for all hematopoietic stem cell transplants (HCT) and cellular therapies. After 25 years, information was available for 11,226 patients receiving an HCT (4031 allogeneic and 7195 autologous), including 925 pediatric patients. We compared patient characteristics and outcome by quinquennia 1997-2001, 2002-2006, 2007-2011, 2012-2016, and 2017-2021. There were numerous changes over time. Allogeneic transplant recipients became older (median age 33.7 vs. 54.3) and had more frequently unrelated donors and reduced intensity conditioning in later quinquennia. Similarly, age increased for recipients of autologous HCT (median 48.3 vs. 59.9). We did not see a significant drop in transplant activity during the SARS-CoV-2 pandemic. Analysis of outcome showed overall survival (relative risk (RR) of death 0.664 (0.529-0.832) and progression free survival (RR 0.708 (0.577-0.870) being improved over time comparing the latest to the first quinquennium adjusting for risk factors. Non-relapse mortality decreased in recipients of allogeneic HCT (RR: 0.371 (0.270-0.509)) over time but relapse risks did not. Outcome of autologous HCT improved as well across quinquennia, this improvement was mainly due to decreased relapse risks (RR 0.681 (0.597-0.777)), possibly related to maintenance treatment or rescue treatment for relapse mainly in myeloma patients. Cellular therapies other than allogeneic or autologous HCT, particularly chimeric antigen receptor T-cells (CAR-T) treatment have started to increase after 2019, year of approval of the first commercial CAR-T product in Switzerland. Data on chimeric antigen receptor T-cell treatment are too early for comparative analyses. Detailed analyses of changes over time are presented. This study includes all HCTs, and cellular therapies, data useful for quality assurance programs, health care cost estimation and benchmarking. Between 50% and 60% of patients are long-term survivors after both types of HCT, indicating growing populations of surviving patients requiring long-term care.
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Affiliation(s)
- Jakob R Passweg
- Hematology Division and Pediatric Hematology-oncology University Hospital and Children's University Hospital, Basel, Switzerland
| | - Helen Baldomero
- SBST Data Registry Office, University Hospital, Basel, Switzerland
| | - Marc Ansari
- Division of Hematology, Division of Pediatric Oncology and Hematology, University Hospital Geneva (HUG), Cansearch Research Platform for Pediatric Oncology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Caroline Arber
- Service and Central Laboratory of Hematology, Service of Immunooncology, Departments of Oncology, Laboratory Medicine and Pathology, University Hospital, Lausanne, Switzerland
| | - Yves Chalandon
- Division of Hematology, Division of Pediatric Oncology and Hematology, University Hospital Geneva (HUG), Cansearch Research Platform for Pediatric Oncology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michael Daskalakis
- Department of Medical Oncology, Department of Hematology and Central Hematology Laboratory, Division of Hematology/Oncology Department of Pediatrics University Hospital Inselspital and University of Berne, Bern, Switzerland
| | - Miriam Diepold
- Department of Medical Oncology, Department of Hematology and Central Hematology Laboratory, Division of Hematology/Oncology Department of Pediatrics University Hospital Inselspital and University of Berne, Bern, Switzerland
| | - Tamara Diesch-Furlanetto
- Hematology Division and Pediatric Hematology-oncology University Hospital and Children's University Hospital, Basel, Switzerland
| | - Michel A Duchosal
- Service and Central Laboratory of Hematology, Service of Immunooncology, Departments of Oncology, Laboratory Medicine and Pathology, University Hospital, Lausanne, Switzerland
| | - Sabine Gerull
- Division of Hematology/Oncology, Kantonsspital, Gt. Gallen, Switzerland
| | - Tayfun Güngör
- Department of Immunology/Hematology/Oncology/Stem Cell Transplantation and Gene-Therapy, University Children's Hospital, Zurich, Switzerland
| | - Dominik Heim
- Hematology Division and Pediatric Hematology-oncology University Hospital and Children's University Hospital, Basel, Switzerland
| | - Felicitas Hitz
- Division of Medical Oncology and Hematology, Kantonsspital, St. Gallen, Switzerland
| | - Andreas Holbro
- Hematology Division and Pediatric Hematology-oncology University Hospital and Children's University Hospital, Basel, Switzerland
| | - Stavroula Masouridi-Levrat
- Division of Hematology, Division of Pediatric Oncology and Hematology, University Hospital Geneva (HUG), Cansearch Research Platform for Pediatric Oncology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gayathri Nair
- Swiss Blood Stem Cells, Donor Registry, Swiss Transfusion SRC, Berne, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Department of Hematology and Central Hematology Laboratory, Division of Hematology/Oncology Department of Pediatrics University Hospital Inselspital and University of Berne, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Department of Hematology and Central Hematology Laboratory, Division of Hematology/Oncology Department of Pediatrics University Hospital Inselspital and University of Berne, Bern, Switzerland
| | - Christoph Renner
- Division of Hematology/Oncology, Clinic Hirslanden, Zurich, Switzerland
| | - Georg Stussi
- Division of Hematology, Istituto Oncologico Della Svizzera Italiana, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Dominik Schneidawind
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Urs Schanz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Luciano Wannesson
- Division of Hematology, Istituto Oncologico Della Svizzera Italiana, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Jörg P Halter
- Hematology Division and Pediatric Hematology-oncology University Hospital and Children's University Hospital, Basel, Switzerland
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Syngeneic hematopoietic stem cell transplantation for acute myeloid leukemia: a propensity score-matched analysis. Blood Cancer J 2021; 11:159. [PMID: 34561419 PMCID: PMC8463668 DOI: 10.1038/s41408-021-00553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/08/2022] Open
Abstract
The present study evaluated outcomes and prognostic factors in adult patients with acute myeloid leukemia (AML) after syngeneic hematopoietic stem cell transplantation (HSCT). Among patients in first complete remission (CR1), outcomes of syngeneic HSCT (Syn) were compared with those of autologous HSCT (Auto), allogeneic HSCT from human leukocyte antigen (HLA)-matched sibling donor (MSD), or allogeneic HSCT from HLA-matched unrelated donor (MUD). Among 11,866 patients receiving first HSCT, 26 in the Syn group were analyzed. The 5-year overall survival (OS) rate, the cumulative incidence of relapse, and the cumulative incidence of non-relapse mortality (NRM) were 47.8%, 59.6%, and 4.6%, respectively. The OS was significantly better in patients in CR1 (n = 13) than in patients in non-CR1 (P = 0.012). Furthermore, 39 patients in CR1 each were assigned to the Auto, MSD, and MUD groups using propensity score matching. The 5-year OS in the Syn (68.4%) was not significantly different from those in the Auto (55.9%, P = 0.265), MSD (62.4%, P = 0.419), or MUD (63.7%, P = 0.409) groups. A higher relapse in the Syn than in the MSD and MUD groups was offset by lower NRM. In summary, syngeneic HSCT might be an alternative option for AML patients in CR1.
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