Stronger impact of centre type compared to activity volume and quality management on the performance of autologous hematopoietic stem cell transplants in adults: report of the Belgian Transplant Registry

Objectives Introduction of the JACIE quality management has been shown to improve performance of allogeneic hematopoietic stem cell transplants (HSCT), but its impact on autologous-HSCT remains unclear. We aimed at evaluating performance of Belgian transplant autologous-HSCT centers. Methods Adjusted 1-year and 3-year survivals of 2697 autologous-HSCT performed in adult patients (2007-2013) were compared between the 17 Belgian centres by applying a fixed effects censored data generalized linear regression model. The impact of 3 centre-related factors was investigated: time between JACIE accred... Mehr ...

Verfasser: Poirel Hélène
Graux, Carlos
34th BHS Annual Meeting
Dokumenttyp: conferenceObject
Erscheinungsdatum: 2019
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-29295152
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : http://hdl.handle.net/2078.1/215696

Objectives Introduction of the JACIE quality management has been shown to improve performance of allogeneic hematopoietic stem cell transplants (HSCT), but its impact on autologous-HSCT remains unclear. We aimed at evaluating performance of Belgian transplant autologous-HSCT centers. Methods Adjusted 1-year and 3-year survivals of 2697 autologous-HSCT performed in adult patients (2007-2013) were compared between the 17 Belgian centres by applying a fixed effects censored data generalized linear regression model. The impact of 3 centre-related factors was investigated: time between JACIE accreditation achievement by centre and the considered transplant, centre activity volume and type of HSCT performed by centre (autologous only vs autologous/allogeneic). Results Transplant year, Karnofsky performance status, Disease Risk Index (DRI) and number of transplants were retained for 1-yr survival. In addition to these variables, age at transplantation and time between diagnosis and transplant were selected for 3-yr survival. The overall adjusted survival was 89% at 1 year and 78% at 3 years in Belgium. The performance between Belgian centres was relatively homogeneous before national completeness of JACIE implementation, with 3 centers over- and 2 under-performing at 1 year (1 and 2, respectively, at 3 years). The 3 centre-related factors had a significant impact on 1-yr survival, while only activity volume and type of HSCT did so on 3-yr survival in univariable analyses. In multivariable analyses, only activity volume (impact on 1-yr survival) and type of HSCT (impact on 1-yr and 3-yr survivals) remained significant. Conclusion The absence of impact of JACIE accreditation may be explained by the strong relationship between the 3 centre-related factors and/or by the fact that type of center (auto only versus auto & allo) conveys a multitude of underlying complex factors including accreditation. For the first time, our national study identifies centre activity and type of center as predictors of survival after ...