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Impact of Center Experience with Donor Type on Outcomes: A Secondary Analysis BMT CTN 1101Open for Accrual June 2012Open for Accrual June 2012. Transplantation and cellular therapy Brunstein, C. G., O'Donnell, P. V., Logan, B., Dawson, P., Costa, L., Cutler, C., Craig, M., Hogan, W., M Horowitz, M., Horwitz, M. E., Karanes, C., Magenau, J. M., Malone, A., McCarty, J., McGuirk, J. P., Morris, L. E., Rezvani, A. R., Salit, R., Vasu, S., Eapen, M., Fuchs, E. J. 2022

Abstract

BACKGROUND: We reported on the results of Blood and Marrow Transplant (BMT) Clinical Trials Network (CTN) 1101, a randomized comparison between double umbilical cord blood (dUCB) and haploidentical (haplo) bone marrow (BM) with post-transplant cyclophosphamide (PTCy) in the nonmyeloablative setting that showed similar progression free survival (PFS) between the two treatment groups, but lower non-relapse mortality (NRM) and better of survival (OS) in the haplo arm. In this secondary analysis, we sought to investigate whether transplant center experience with haplo BM and/or dUCB hematopoietic cell transplant (HCT) had an impact on outcomes.PATIENTS AND METHODS: All patients randomized in BMT CTN 1101 were included. Center experience was assigned based on the number transplants with each platform in the year prior to initiation of the study according to the Center for International Blood and Marrow Transplant Research (CIBMTR). Centers were then grouped as a dUCB-center (>10 dUCB, n=117, 10 centers), a haplo center (>10 haplo and =10 dUCB, n=110, 2 centers), or other-center (=10 haplo and =10 dUCB HCTs, n=140, 21 centers).RESULTS: After adjusting for age, Karnofsky performance score, and disease risk index, we found that haplo centers had lower overall mortality with this donor type, as compared to dUCB (HR 2.56, 95%CI, 1.44-4.56). In contrast, there were no differences in overall mortality between haplo and dUCB in centers that were experienced with dUCB (HR 1.02, 95%CI 0.59-1.79) or had limited-to-no experience with either dUCB or haplo (HR 1.36, 95%CI, 0.83-2.21). The higher risk of treatment failure and overall mortality in dUCB in haplo-experienced centers was driven by a significantly higher risk of relapse (HR 1.78, 95%CI, 1.07-2.97).CONCLUSION: With the exception of worse outcomes among dUCB recipients in haplo-BM centers, the transplant center experience on the year prior to the initiation of BMT CTN 1101 had limited impact on the outcomes of this randomized clinical trial.

View details for DOI 10.1016/j.jtct.2022.03.024

View details for PubMedID 35390529