Kurosawa Shuhei, Fukuda Takahiro, Ichinohe Tatsuo, Hashii Yoshiko, Kanda Junya, Goto Hideki, Kato Koji, Ishimaru Fumihiko, Yoshimitsu Makoto, Hino Moeko, Matsuo Keitaro, Ito Yuri, Yanagisawa Atsumi, Ohbiki Marie, Tabuchi Ken, Atsuta Yoshiko, Arai Yasuyuki
Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Division of Transfusion and Cell Therapy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Cytotherapy. 2025 Jun;27(6):733-743. doi: 10.1016/j.jcyt.2025.03.002. Epub 2025 Mar 12.
We evaluated the impact of center volume on outcomes in patients with B-cell acute lymphoblastic leukemia following their second allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our cohort included 299 patients with relapse and 68 patients with graft failure after their first allo-HSCT between 2003 and 2017. Patients were stratified into low- and high-volume groups based on the number of allo-HSCT performed at each center. The primary endpoint was 5-year overall survival (OS) following the second allo-HSCT. In the relapse cohort, the high-volume group demonstrated significantly better 5-year OS (21.1% vs 13.6%, P = 0.0062) and progression-free survival (16.1% vs 10.6%, P = 0.010). Multivariate analysis showed that high-volume group was a favorable factor for OS (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.56-0.94, P = 0.016). This survival benefit was consistent in both Philadelphia chromosome-negative (HR: 0.71, 95% CI: 0.51-0.99, P = 0.042) and positive (HR: 0.61, 95% CI: 0.39-0.95, P = 0.030) subcohorts. In the graft failure cohort, the high-volume group showed a trend toward better 5-year OS (41.6% vs 24.4%, P = 0.098) and lower 5-year nonrelapse mortality (NRM) (55.9% vs 75.6%, P = 0.067). Multivariate analysis confirmed the protective effect of the high-volume group on NRM (HR: 0.55, 95% CI: 0.30-0.99, P = 0.044). Our findings demonstrate that center volume significantly impacts outcomes after the second allo-HSCT regardless of indication, highlighting the need for inter-center collaboration and standardized management strategies for this high-risk population.
我们评估了中心移植量对B细胞急性淋巴细胞白血病患者第二次异基因造血干细胞移植（allo-HSCT）后预后的影响。我们的队列包括2003年至2017年间首次allo-HSCT后复发的299例患者和移植失败的68例患者。根据每个中心进行的allo-HSCT数量，将患者分为低移植量组和高移植量组。主要终点是第二次allo-HSCT后的5年总生存率（OS）。在复发队列中，高移植量组的5年OS显著更好（21.1%对13.6%，P = 0.0062），无进展生存期也更好（16.1%对10.6%，P = 0.010）。多变量分析显示，高移植量组是OS的有利因素（风险比[HR]：0.72，95%置信区间[CI]：0.56 - 0.94，P = 0.016）。这种生存获益在费城染色体阴性（HR：0.71，95% CI：0.51 - 0.99，P = 0.042）和阳性（HR：0.61，95% CI：0.39 - 0.95，P = 0.030）亚组中均一致。在移植失败队列中，高移植量组显示出5年OS更好的趋势（41.6%对24.4%，P = 0.098），5年非复发死亡率更低（55.9%对75.6%，P = 0.067）。多变量分析证实了高移植量组对非复发死亡率的保护作用（HR：0.55，95% CI：0.30 - 0.99，P = 0.044）。我们的研究结果表明，无论适应证如何，中心移植量对第二次allo-HSCT后的预后有显著影响，突出了该高危人群中心间合作和标准化管理策略的必要性。
