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Survival Trends in Infants Undergoing Allogeneic Hematopoietic Cell Transplant. JAMA Pediatr 2019 05 01;173(5):e190081

Date

03/19/2019

Pubmed ID

30882883

Pubmed Central ID

PMC6503511

DOI

10.1001/jamapediatrics.2019.0081

Scopus ID

2-s2.0-85062953980

Abstract

Importance: Studies demonstrating improved survival after allogeneic hematopoietic cell transplant generally exclude infants.

Objective: To analyze overall survival trends and other outcomes among infants who undergo allogeneic hematopoietic cell transplant.

Design, Setting, and Participants: In this cohort study, we used time-trend analysis to evaluate 3 periods: 2000 through 2004, 2005 through 2009, and 2010 through 2014. The study was conducted in a multicenter setting through the Center for International Blood and Marrow Transplant Research, which is made up of a voluntary working group of more than 450 transplant centers worldwide. Two groups of infants aged 1 year or younger in 2 cohorts were included: those with malignant conditions, such as leukemia, and those with nonmalignant disorders, including immunodeficiencies. Data analysis was conducted from July 2017 to December 2018.

Exposures: Allogeneic hematopoietic cell transplant.

Main Outcomes and Measures: Survival trends, disease relapse, and toxicity.

Results: A total of 2498 infants with a median age of 7 months (range, <1-12 months) were included. In the nonmalignant cohort (n = 472), survival rates improved from the first to the second period (hazard ratio, 0.77 [95% CI, 0.63-0.93]; P = .007) but did not change after 2004. Compared with infants with nonmalignant diseases (n = 2026; 3-year overall survival: 2000-2004, 375/577 [65.0%]; 2005-2009, 503/699 [72.0%]; and 2010-2014, 555/750 [74.0%]), those with malignant conditions had poorer survival rates, without improvement over time (3-year overall survival: 2000-2004, 109/199 [54.8%]; 2005-2009, 104/161 [64.6%]; and 2010-2014, 66/112 [58.9%]). From 2000 through 2014, relapse rates increased in infants with malignant conditions (3-year relapse rate: 2000-2004, 19% [95% CI, 14%-25%]; 2005-2009, 23% [95% CI, 17%-30%]; 2010-2014, 36% [95% CI, 27%-46%]; P = .01). Sinusoidal obstruction syndrome was frequent, occurring with a cumulative incidence of 13% (95% CI, 11%-16%) of infants with nonmalignant diseases and 32% (95% CI, 22%-42%) of those with malignant diseases. Generally, recipients of human leukocyte antigen-identical sibling bone marrow grafts had the best outcomes.

Conclusions and Relevance: Survival rates have not improved for infants with malignant diseases over the 15-year study period. Infants with nonmalignant diseases had improved survival rates in the earlier but not the later study period. Higher relapses for the malignant cohort and toxicities for all infants remain significant challenges. Strategies to reduce relapse and toxicity and optimize donor and graft selection may improve outcomes in the future.

Author List

Parikh SH, Satwani P, Ahn KW, Sahr NA, Fretham C, Abraham AA, Agrawal V, Auletta JJ, Abdel-Azim H, Copelan E, Diaz MA, Dvorak CC, Frangoul HA, Freytes CO, Gadalla SM, Gale RP, George B, Gergis U, Hashmi S, Hematti P, Hildebrandt GC, Keating AK, Lazarus HM, Myers KC, Olsson RF, Prestidge T, Rotz SJ, Savani BN, Shereck EB, Williams KM, Wirk B, Pasquini MC, Loren AW

Authors

Kwang Woo Ahn PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Marcelo C. Pasquini MD, MS Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cause of Death
Cohort Studies
Female
Hematopoietic Stem Cell Transplantation
Hepatic Veno-Occlusive Disease
Humans
Immunologic Deficiency Syndromes
Incidence
Infant
Infant, Newborn
Leukemia
Lung Diseases, Interstitial
Male
Mortality
Recurrence
Severe Combined Immunodeficiency
Survival Rate
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a