Should HLA-Identical Sibling Bone Marrow Transplants for Leukemia Be Restricted to Large Centers?
There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in...
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| Veröffentlicht in: | Blood 1992-05, Vol.79 (10), p.2771-2774 |
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| creator | Horowitz, Mary M. Przepiorka, Donna Champlin, Richard E. Gale, Robert Peter Gratwohl, Alois Herzig, Roger H. Prentice, H. Grant Rimm, Alfred A. Rinqdén, Olle Bortin, Mortimer M. |
| description | There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment-related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome. |
| doi_str_mv | 10.1182/blood.V79.10.2771.2771 |
| format | Article |
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Grant ; Rimm, Alfred A. ; Rinqdén, Olle ; Bortin, Mortimer M.</creator><creatorcontrib>Horowitz, Mary M. ; Przepiorka, Donna ; Champlin, Richard E. ; Gale, Robert Peter ; Gratwohl, Alois ; Herzig, Roger H. ; Prentice, H. Grant ; Rimm, Alfred A. ; Rinqdén, Olle ; Bortin, Mortimer M.</creatorcontrib><description>There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment-related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood.V79.10.2771.2771</identifier><identifier>PMID: 1586723</identifier><language>eng</language><publisher>Washington, DC: Elsevier Inc</publisher><subject>Adult ; Analysis of Variance ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Bone Marrow Transplantation - immunology ; Bone Marrow Transplantation - standards ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Follow-Up Studies ; Histocompatibility Testing ; HLA Antigens - immunology ; Humans ; Leukemia - immunology ; Leukemia - surgery ; Medical sciences ; Nuclear Family ; Probability ; Registries ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Treatment Outcome</subject><ispartof>Blood, 1992-05, Vol.79 (10), p.2771-2774</ispartof><rights>1992 American Society of Hematology</rights><rights>1992 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-60fca407a8500cf5e8afd823e5610da8813b337341b2b5bce5c309d0dd33cc673</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5351300$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1586723$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Horowitz, Mary M.</creatorcontrib><creatorcontrib>Przepiorka, Donna</creatorcontrib><creatorcontrib>Champlin, Richard E.</creatorcontrib><creatorcontrib>Gale, Robert Peter</creatorcontrib><creatorcontrib>Gratwohl, Alois</creatorcontrib><creatorcontrib>Herzig, Roger H.</creatorcontrib><creatorcontrib>Prentice, H. Grant</creatorcontrib><creatorcontrib>Rimm, Alfred A.</creatorcontrib><creatorcontrib>Rinqdén, Olle</creatorcontrib><creatorcontrib>Bortin, Mortimer M.</creatorcontrib><title>Should HLA-Identical Sibling Bone Marrow Transplants for Leukemia Be Restricted to Large Centers?</title><title>Blood</title><addtitle>Blood</addtitle><description>There is substantial evidence that the volume of medical procedures in a hospital has an inverse relationship with mortality. We analyzed data for 1313 recipients of HLA-identical sibling bone marrow transplants for early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in first chronic phase) to determine whether transplant outcome differed in small and large centers. Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment-related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. Among patients receiving transplants in centers performing more than five transplants a year, there was no statistically significant correlation between number of transplants and outcome.</description><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone Marrow Transplantation - immunology</subject><subject>Bone Marrow Transplantation - standards</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Follow-Up Studies</subject><subject>Histocompatibility Testing</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Leukemia - immunology</subject><subject>Leukemia - surgery</subject><subject>Medical sciences</subject><subject>Nuclear Family</subject><subject>Probability</subject><subject>Registries</subject><subject>Transfusions. Complications. Transfusion reactions. 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Grant</creator><creator>Rimm, Alfred A.</creator><creator>Rinqdén, Olle</creator><creator>Bortin, Mortimer M.</creator><general>Elsevier Inc</general><general>The Americain Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19920515</creationdate><title>Should HLA-Identical Sibling Bone Marrow Transplants for Leukemia Be Restricted to Large Centers?</title><author>Horowitz, Mary M. ; Przepiorka, Donna ; Champlin, Richard E. ; Gale, Robert Peter ; Gratwohl, Alois ; Herzig, Roger H. ; Prentice, H. 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Grant</creatorcontrib><creatorcontrib>Rimm, Alfred A.</creatorcontrib><creatorcontrib>Rinqdén, Olle</creatorcontrib><creatorcontrib>Bortin, Mortimer M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Blood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Horowitz, Mary M.</au><au>Przepiorka, Donna</au><au>Champlin, Richard E.</au><au>Gale, Robert Peter</au><au>Gratwohl, Alois</au><au>Herzig, Roger H.</au><au>Prentice, H. 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Transplants were performed in 86 bone marrow transplant centers active between the years 1983 and 1988, which participated in the International Bone Marrow Transplant Registry. Twenty-one (24%) centers performed five or fewer allogeneic transplants per year during the study period; five (6%) performed more than 40 per year. After adjustment for differences in patient and disease characteristics, the relative risks of treatment-related mortality (1.53, P less than .01) and treatment failure (1.38, P less than .04) were higher among patients who received transplants at centers doing five or fewer transplants per year than among those at larger centers. 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| subjects | Adult Analysis of Variance Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Bone Marrow Transplantation - immunology Bone Marrow Transplantation - standards Bone marrow, stem cells transplantation. Graft versus host reaction Follow-Up Studies Histocompatibility Testing HLA Antigens - immunology Humans Leukemia - immunology Leukemia - surgery Medical sciences Nuclear Family Probability Registries Transfusions. Complications. Transfusion reactions. Cell and gene therapy Treatment Outcome |
| title | Should HLA-Identical Sibling Bone Marrow Transplants for Leukemia Be Restricted to Large Centers? |
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