Bethge Wolfgang, Flossdorf Sarah, Hanke Franziska, Schmid Christoph, Ringhoffer Mark, Klein Stefan, Hertenstein Bernd, Schetelig Johannes, Stelljes Matthias, Schroeder Thomas, Blau Igor Wolfgang, Ayuk Francis, Eder Matthias, Zeiser Robert, Fleischhauer Katharina, Kröger Nicolaus, Dreger Peter
University Hospital Tuebingen, Tuebingen, Germany; German Working Group for Hematopoietic Stem Cell Transplantation and Cellular Therapy.
Institute for Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; German Registry for Hematopoietic Stem Cell Transplantation and Cell Therapy, Ulm.
Haematologica. 2025 Jun 1;110(6):1292-1303. doi: 10.3324/haematol.2024.286385. Epub 2024 Dec 5.
We investigated the effect of center-specific variables on overall survival (OS) after allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML). Eligible for the study were adult patients reported to the German Registry for Hematopoietic Stem Cell Transplantation and Cell Therapy (DRST) receiving first alloHCT for AML from a related or matched (>9/10 HLA-match) unrelated donor in the period 2015-2021. Primary endpoint was OS at 12 months from alloHCT. Univariable and multivariable analyses after best subset selection were performed. Of 5,328 patients, 83% received alloHCT in a high-volume center (≥40 alloHCT/year), 90% in a university hospital, 90% in a center performing alloHCT for ≥10 years, and 73% in a Joint Accreditation Committee ISCT-Europe and European Group for Blood and Marrow Transplantation (EBMT) (JACIE) accredited center. 52% of the patients were in first CR, and European LeukemiaNet risk was adverse in 37% and intermediate in 42%. On multivariable analysis, center-specific factors predicting adverse 12-month OS were program duration <5-10 years (Hazard Ratio [HR] 1.23, [95% Confidence Interval: [1.02; 1.49]), center volume <40 alloHCT/year (HR 1.21, [1.02; 1.45]), and treatment at a non-university hospital (HR 1.21, [0.98; 1.49]), whereas JACIE accreditation did not. Spline modeling suggested a negative effect of a center volume up to 45 alloHCT per year. Center volume, center experience, university hospital, but not JACIE accreditation, have an impact on alloHCT outcomes in adult patients with AML in Germany.
我们研究了特定中心变量对急性髓系白血病（AML）患者异基因造血细胞移植（alloHCT）后总生存期（OS）的影响。纳入研究的对象为2015年至2021年期间向德国造血干细胞移植和细胞治疗登记处（DRST）报告的成年患者，这些患者接受了来自相关或匹配（>9/10 HLA匹配）的无关供体的首次AML alloHCT。主要终点是alloHCT后12个月的OS。进行了最佳子集选择后的单变量和多变量分析。在5328例患者中，83%在大容量中心（≥40例alloHCT/年）接受alloHCT，90%在大学医院，90%在进行alloHCT≥10年的中心，73%在获得欧洲细胞治疗认证委员会（JACIE）和欧洲血液与骨髓移植组（EBMT）认证的中心。52%的患者处于首次完全缓解期，37%的患者欧洲白血病网风险为不良，42%为中等。多变量分析显示，预测12个月OS不良的特定中心因素包括项目持续时间<5至10年（风险比[HR] 1.23，[95%置信区间：[1.02；1.49]）、中心容量<40例alloHCT/年（HR 1.21，[1.02；1.45]）以及在非大学医院接受治疗（HR 1.21，[0.98；1.49]），而JACIE认证则无此影响。样条模型显示，每年中心容量达45例alloHCT有负面影响。在德国，中心容量、中心经验、大学医院对成年AML患者alloHCT结局有影响，但JACIE认证无此影响。
