Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 148 No. 0910 (2018)

Haematopoietic cell transplantation in Switzerland, changes and results over 20 years: a report from the Swiss Blood Stem Cell Transplantation Working Group for Blood and Marrow Transplantation registry 1997–2016

DOI
https://doi.org/10.4414/smw.2018.14589
Cite this as:
Swiss Med Wkly. 2018;148:w14589
Published
01.03.2018

Abstract

In 1997, the Swiss Blood Stem Cell Transplantation Group (SBST) initiated a mandatory national registry for all haematopoietic stem cell transplants (HCTs) in Switzerland. As of 2016, after 20 years, information was available for 7899 patients who had received an HCT (2781 allogeneic [35%] and 5118 autologous [65%]). As some patients had more than one transplant the total number of transplants was 3067 allogeneic and 6448 autologous. We compared patient characteristics and outcome of the first decade (1997–2006) and second decade (2007-2016) of the registry. There were numerous changes over time. For allogeneic HCT, transplant rates, and therefore use of HCT technology, increased from 14 to 21.8 HCTs per 1 million inhabitants per year from the first to the second decade. Likewise autologous HCTs increased from 24.8 to 37.2 annually corrected for population growth. Allogeneic transplant recipients were older (38.4 vs 48.3 years) and more frequently had unrelated donors in the second decade. Similarly, age increased for recipients of autologous HCT (50.8 vs 56.4 years).

Analysis of outcome showed that the probabilities of overall and progression-free survival were stable over time, in spite of the treatment of older and higher risk patients. In multivariate analysis, nonrelapse mortality decreased in recipients of allogeneic HCT (relative risk 0.68, 95% confidence interval 0.52–0.87) over the two decades. Improvement in adjusted nonrelapse mortality compensated for the fact that higher risk patients were treated in more recent years, resulting in similar overall survival. Five-year survival probabilities were 56% (53–59%) in the first and 54% (51–57%) in the second decade for allogeneic HCT, and 59% (57–61%) in the first and 61% (59–63%) in the second decade for autologous HCT. Detailed analyses of changes over time are presented. This study included all HCTs performed in Switzerland during the period of observation and the data are useful for quality assurance programmes, healthcare cost estimation and healthcare planning. Between 50 and 60% of patients were long-term survivors after both types of HCT, indicating growing populations of surviving patients requiring long-term care and observation.

References

  1. Gratwohl A, Gmür J, Chapuis B, Baumgartner C, Würsch A, Lori A, et al. 12 Jahre Knochenmarktransplantation bei Leukämien in der Schweiz. [12 years’ experience in bone marrow transplantation in leukemic patients in Switzerland]. Schweiz Med Wochenschr. 1986;116(43):1477–8. Article in German.
  2. Leibundgut K, Hirt A, Lüthy AR, Wagner HP, Tobler A. Single institution experience with mobilization, harvesting, and reinfusion of peripheral blood stem cells in children with a solid tumor or leukemia. Pediatr Hematol Oncol. 1994;11(2):215–21. doi:.https://doi.org/10.3109/08880019409141660
  3. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med. 2006;354(17):1813–26. doi:.https://doi.org/10.1056/NEJMra052638
  4. Gratwohl A, Hermans J, Goldman JM, Arcese W, Carreras E, Devergie A, et al.; Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Lancet. 1998;352(9134):1087–92. doi:.https://doi.org/10.1016/S0140-6736(98)03030-X
  5. Appelbaum FR. Hematopoietic-cell transplantation at 50. N Engl J Med. 2007;357(15):1472–5. doi:.https://doi.org/10.1056/NEJMp078166
  6. Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al.; Worldwide Network for Blood and Marrow Transplantation (WBMT). One million haemopoietic stem-cell transplants: a retrospective observational study. Lancet Haematol. 2015;2(3):e91–100. doi:.https://doi.org/10.1016/S2352-3026(15)00028-9
  7. Tyndall A. Successes and failures of stem cell transplantation in autoimmune diseases. Hematology (Am Soc Hematol Educ Program). 2011;2011(1):280–4. doi:.https://doi.org/10.1182/asheducation-2011.1.280
  8. Passweg J, Baldomero H, Chapuis B, Leibundgut K, Schanz U, Gratwohl A ; Swiss Transplant Working Group Blood and Marrow Transplantation Board. Haematopoietic stem cell transplantation in Switzerland. Report from the Swiss Transplant Working Group Blood and Marrow Transplantation (STABMT) Registry 1997-2003. Swiss Med Wkly. 2006;136(3-4):50–8. doi:https://smw.ch/en/article/doi/smw.2006.11286/.
  9. Passweg J, Baldomero H, Stern M, Bargetzi M, Ghielmini M, Leibundgut K, et al.; Swiss Blood and Marrow Stem Cells Transplant Group (SBST). Hematopoietic stem cell transplantation in Switzerland: a comprehensive quality control report on centre effect. Swiss Med Wkly. 2010;140(23-24):326–34. doi:https://smw.ch/en/article/doi/smw.2010.12978/.
  10. Sureda A, Bader P, Cesaro S, Dreger P, Duarte RF, Dufour C, et al. Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant. 2015;50(8):1037–56. doi:.https://doi.org/10.1038/bmt.2015.6
  11. Klein JP, Wu TJ. Handbook of Statistics: Advances in Survival Analysis Discretizing a Continuous Covariate in Survival Studies. Amsterdam: Elseiver; 2004.
  12. Passweg JR, Baldomero H, Bargetzi M, Bucher C, Chalandon Y, Duchosal MA, et al.; SBST (Swiss Blood Stem Cell Transplantation Group). Haematopoietic stem cell transplantation: activity in Switzerland compared with surrounding European countries. Swiss Med Wkly. 2013;143:w13757. doi:https://smw.ch/en/article/doi/smw.2013.13757/.
  13. Passweg JR, Baldomero H, Gratwohl A, Bregni M, Cesaro S, Dreger P, et al.; European Group for Blood and Marrow Transplantation (EBMT). The EBMT activity survey: 1990-2010. Bone Marrow Transplant. 2012;47(7):906–23. doi:.https://doi.org/10.1038/bmt.2012.66
  14. Attal M, Lauwers-Cances V, Hulin C, Leleu X, Caillot D, Escoffre M, et al.; IFM 2009 Study. Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma. N Engl J Med. 2017;376(14):1311–20. doi:.https://doi.org/10.1056/NEJMoa1611750
  15. Gratwohl A, Stern M, Brand R, Apperley J, Baldomero H, de Witte T, et al.; European Group for Blood and Marrow Transplantation and the European Leukemia Net. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009;115(20):4715–26. doi:.https://doi.org/10.1002/cncr.24531
  16. Muffly L, Pasquini MC, Martens M, Brazauskas R, Zhu X, Adekola K, et al. Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood. 2017;130(9):1156–64. doi:.https://doi.org/10.1182/blood-2017-03-772368
  17. ElSawy M, Storer BE, Pulsipher MA, Maziarz RT, Bhatia S, Maris MB, et al. Multi-centre validation of the prognostic value of the haematopoietic cell transplantation- specific comorbidity index among recipient of allogeneic haematopoietic cell transplantation. Br J Haematol. 2015;170(4):574–83. doi:.https://doi.org/10.1111/bjh.13476
  18. Artz AS. Biologic vs physiologic age in the transplant candidate. Hematology (Am Soc Hematol Educ Program). 2016;2016(1):99–105. doi:.https://doi.org/10.1182/asheducation-2016.1.99
  19. Hahn T, McCarthy PL, Jr, Hassebroek A, Bredeson C, Gajewski JL, Hale GA, et al. Significant improvement in survival after allogeneic hematopoietic cell transplantation during a period of significantly increased use, older recipient age, and use of unrelated donors. J Clin Oncol. 2013;31(19):2437–49. doi:.https://doi.org/10.1200/JCO.2012.46.6193
  20. Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, et al. Impact of drug development on the use of stem cell transplantation: a report by the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2017;52(2):191–6. doi:.https://doi.org/10.1038/bmt.2016.258
  21. Gay F, Engelhardt M, Terpos E, Wäsch R, Giaccone L, Auner HW, et al. From transplant to novel cellular therapies in multiple myeloma: EMN guidelines and future perspectives. Haematologica. 2017;haematol.2017.174573; Epub ahead of print. doi:.https://doi.org/10.3324/haematol.2017.174573

Most read articles by the same author(s)

1 2 3 > >>