Comparing outcome between Belgian haematopoietic stem cell transplant centres

Transcription

1 ENCR2016, 2014/06/10 1 Comparing outcome between Belgian haematopoietic stem cell transplant centres Gilles Macq 1, Evelien Vaes 1, Geert Silversmit 1, Marijke Vanspauwen 1, Liesbet Van Eycken 1 & Yves Beguin 2 on behalf of the steering committee of the Belgian Transplant Committee 1 Belgian Cancer Registry, rue royale 215, 1210 Brussels, Belgium 2 Université de Liège & CHU de Liège, Department of Hematology, Liège, Belgium 11

2 Evaluation of Belgian HSCT centres Goal of the study: compare outcome among Belgian HSCT centres Fair evaluation Case-mix differs between centres : can have a direct impact on outcome Centres results should be adjusted for case mix 2

3 CIBMTR 3

4 Methodology / introduction Belgian Transplant Registry - cooperation between BHS Transplant Committee & its centers Belgian Cancer Registry Foundation against Cancer : financial support - steering committee defines objectives, methodology, endpoints & covariates, scores Centers - enter data into EBMT Promise database - give permission to BTR to extract Promise data - answer queries Cancer registry - extracts Promise data into its database - verifies data / collects missing data ( & on-site) & transfers into Promise - obtains survival status from national database - runs statistical analyses - prepares general report & individual feedback to each center 4

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6 Do not analyze centers with < 5 HSCT per year

7 Allo Center Transplant year Age Sex Race Karnofsky CMV status Disease risk index (Armand) Time from diagnosis Conditioning Stem cell source HLA matching Comorbidity HCT-CI Transplant number Donor age Donor sex match Donor CMV match EBMT risk score Auto Center Transplant year Age Sex Race Karnofsky Disease risk index (Armand) Comorbidity HCT-CI Transplant number EBMT risk score Then do not use age, DRI, disease stage, time diag 1 & 2 Then do not use age, DRI, disease stage, time diag 1 & 2, HLA match, donor sex match

8 Standardisations under performing over performing KM estimate CI of predicted standardised survival Centre (type 3 test) p<0.05 8

9 D(isease) based on diagnostic categories S(tage) based on disease status at transplant C(ytogenetics) only applicable for MDS and AML.

10 Disease Cytogenetics Stage N patients HR* Original DRI New DRI Group AML CR Low Low Fav cytog Advanced Int High Intermed cytog Adverse cytog CR CR Int High Int High Advanced Advanced High Very high High Very high ALL CR Int Int CR Int High CR Int High Advanced High Very high Early Int Int MDS Low-risk D(isease) based Intermed on cytog diagnostic categories MDS high-risk S(tage) based on Intermed disease cytog status at transplant Myeloproliferative neoplasm Any Int Int C(ytogenetics) only applicable for MDS and AML. CML CLL Indolent NHL Mantle cell lymphoma T-cell NHL Aggressive NHL Burkitt lymphoma Hodgkin lymphoma Multiple myeloma Bone marrow failure (including AA) Inherited disorders Auto-immune diseases Hemoglobinopathies Histiocytic disorders Solid tumors (other malignancies & breast cancer) Adverse cytog Adverse cytog Advanced Int Int Early High Int Advanced Very high High Early Int Int Advanced Int High Early High High Advanced Very high High Chronic phase 1/ Low Low Accelerated phase Int Int Blast phase Int Very high CR Low Low PR Low Low Advanced Int Int CR Low Low PR Low Low Advanced Int Int CR Int Low PR Int Int Advanced High High CR Int Int PR Int Int Advanced High High CR Int Int PR Int Int Advanced High Very high CR NA High PR-Advanced NA Very high CR Int Low PR Int Int Advanced High High CR/VGPR/PR Int Int Advanced High High Low Low Low Low Int EXCLUDE

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13 EBMT risk score Age Disease stage Early Intermediate Late Time diagnosis to transplant 2 (mo) < 12 (or CR1) 12 Donor type HLA-id sib (or auto) Other Donor sex match Other F to M Disease stage Early Intermediate Late CML 1st CP Other Blast crisis Acute leukemia (AML-ALL) CR1 CR2 Other MDS Untreated-CR1 CR2-PR Other * Lymphoma (incl Hodgkin) Untreated-CR1 CR2-PR-Stable disease Other MM (incl plasma cell disorders) Untreated-CR1 CR2-PR-Stable disease Other SAA All MPN Untreated-CR1 CR2-PR Other * MDS/MPN Untreated-CR1 CR2-PR Other * Other leukemias (CLL) Untreated-CR1 CR2-PR-Stable disease Other Bone marrow failure All Inherited disorders All Auto-immune diseases All Hemoglobinopathies All Histiocytic disorders All Solid tumors (other malign & BC) EXCLUDE EBMT risk score

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15 Volume of activity Auto- vs allo-hsct

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17 Autologous HSCT 1-yr & 3-yr unadjusted survival

18 Allogeneic HSCT 1-yr & 3-yr unadjusted survival

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22 Autologous HSCT 1-yr & 3-yr adjusted survival

23 Allogeneic HSCT 1-yr & 3-yr adjusted survival

24 Cumulative TRM

25 Transplant indications (EBMT 2010) Standard/optional vs not recommended

26 Transplant indications (EBMT 2015) Standard/optional vs not recommended

27 Conclusions Belgian Transplant Registry fully operational at Cancer Registry Comparative outcome analysis with benchmarking feasible using existing data and sophisticated statistical analyses Result dissemination - BTR steering committee enlarged to all centers - Report to individual centers - Presentations at meetings - Publication - Website? General public? Authorities? Yearly updates? 27

28 Acknowledgments Cancer Registry Gilles Macq, Evelien Vaes, Geert Silversmit, Marijke Vanspauwen, Liesbet Van Eycken Steering committee Centers