Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases

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Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases

Snowden, John A. (författare): Sheffield Teaching Hosp Natl Hlth Serv Fdn Trust, Dept Haematol, Sheffield, S Yorkshire, England.

Badoglio, Manuela (författare): Univ Paris 06, European Soc Blood & Marrow Transplantat EBMT Par, Paris, France.

Labopin, Myriam (författare): Univ Paris 06, St Antoine Hosp, Dept Haematol, INSERM,UMR 938, Paris, France.

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Giebel, Sebastian (författare): Maria Sklodowska Curie Inst, Gliwice Branch, Dept Bone Marrow Transplantat & Oncohematol, Oncol Ctr, Gliwice, Poland.

McGrath, Eoin (författare): Int Soc Cellular Therapy & EBMT JACIE Off, Joint Accreditat Comm, Barcelona, Spain.

Marjanovic, Zora (författare): Hop St Antoine, AP HP, Serv Hematol Clin & Therapie Cellulaire, Paris, France.

Burman, Joachim, 1974- (författare): Uppsala universitet,Neurologi

Moore, John (författare): St Vincents Hlth Network, Dept Haematol, Darlinghurst, NSW, Australia.

Rovira, Montserrat (författare): Hosp Clin Barcelona, Dept Haematol, Barcelona, Spain.

Wulffraat, Nico M. (författare): Wilhelmina Childrens Hosp, Div Kinderen Cluster Immunol Reumatol Hematol & I, Utrecht, Netherlands.

Kazmi, Majid (författare): Guys Hosp, Dept Haematol, Kings Hlth Partners, London, England.

Greco, Raffaella (författare): Ist Ricovero & Cura Carattere Sci, San Raffaele Sci Inst, Hematol & Bone Marrow Transplantat Unit, Milan, Italy.

Snarski, Emilian (författare): Med Univ Warsaw, Dept Hematol Oncol & Internal Dis, Warsaw, Poland.

Kozak, Tomas (författare): Univ Karlovy, Prednosta Interni Hematol Klin, Prague, Czech Republic.;Fak Nemocnice Kralovsk Vinohrady, Prague, Czech Republic.

Kirgizov, Kirill (författare): Dmitry Rogachev Natl Res Ctr Pediat Hematol Oncol, Dept Sci Studies & Clin Technol, Moscow, Russia.

Alexander, Tobias (författare): Charite, Klin Rheumatol & Klin Immunol, Berlin, Germany.

Bader, Peter (författare): Klin Kinder & Jugendmed, Stammzelltransplantat & Immunol, Frankfurt, Germany.

Saccardi, Riccardo (författare): Careggi Univ Hosp, Haematol Dept, Florence, Italy.

Farge, Dominique (författare): Paris Denis Diderot Univ, Hop St Louis, AP HP,Unite Fonct 04,INSERM,UMR 1160, Unite Clin Med Interne Malad Autoimmunes & Pathol, Paris, France.;Filiere FAI2R, Ctr Reference Malad Autoimmunes Syst Rares Ile de, Site Constitutif, Paris, France.

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Sheffield Teaching Hosp Natl Hlth Serv Fdn Trust, Dept Haematol, Sheffield, S Yorkshire, England Univ Paris 06, European Soc Blood & Marrow Transplantat EBMT Par, Paris, France. (creator_code:org_t)

2017-12-20
2017
Engelska.
Ingår i: Blood Advances. - : AMER SOC HEMATOLOGY. - 2473-9529 .- 2473-9537. ; 1:27, s. 2742-2755

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Hematopoietic stem cell transplantation (HSCT) has evolved for >20 years as a specific treatment of patients with autoimmune disease (AD). Using European Society for Blood and Marrow Transplantation registry data, we summarized trends and identified factors influencing activity and outcomes in patients with AD undergoing first autologous HSCT (n = 1951; median age, 37 years [3-76]) and allogeneic HSCT (n = 105; median age, 12 years [<1-62]) in 247 centers in 40 countries from 1994 to 2015. Predominant countries of activity were Italy, Germany, Sweden, the United Kingdom, The Netherlands, Spain, France, and Australia. National activity correlated with the Human Development Index (P = .006). For autologous HSCT, outcomes varied significantly between diseases. There was chronological improvement in progression-free survival (PFS, P < 10(-5)), relapse/ progression (P < 10(-5)), and nonrelapse mortality (P = .01). Health care expenditure was associated with improved outcomes in systemic sclerosis and multiple sclerosis (MS). On multivariate analysis selecting adults for MS, systemic sclerosis, and Crohn disease, better PFSwas associated with experience (>= 23 transplants for AD, P = .001), learning (time from first HSCT for AD >= 6 years, P = .01), and Joint Accreditation Committee of the International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation accreditation status (P = .02). Despite improved survival over time (P = .02), allogeneic HSCT use remained low and largely restricted to pediatric practice. Autologous HSCT has evolved into a treatment modality to be considered alongside other modern therapies in severe AD. Center experience, accreditation, interspecialty networking, and national socioeconomic factors are relevant for health service delivery of HSCT in AD.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Hematologi

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Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases

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