Impact of Transplant Center Volume on Pediatric Allogeneic HCT Outcomes

Overview

This nationwide registry study analyzed 6966 pediatric allogeneic hematopoietic cell transplants (HCT) across 123 centers over 20 years to assess the influence of center volume on survival outcomes. The 5-year overall survival (OS) rates were similar across low- to high-volume centers, with no statistically significant differences observed.

Background

Allogeneic hematopoietic cell transplantation offers curative potential for various pediatric conditions including leukemia, bone marrow failure, immune deficiencies, and metabolic disorders. Post-transplant complications and survival can be influenced by multiple factors, including institutional experience and center volume. While adult studies have suggested a possible center effect on outcomes, pediatric transplantation differs in disease spectrum and experience accumulation, warranting specific investigation. This study aimed to clarify the relationship between transplant center volume and pediatric HCT outcomes using comprehensive national registry data.

Data Highlights

Key Findings

• A total of 6966 pediatric patients underwent allogeneic HCT at 123 centers over 20 years.
• Centers were stratified into four volume categories (C1 to C4) based on total transplant numbers.
• Higher volume centers (C3 and C4) treated a relatively higher proportion of non-malignant diseases and performed fewer umbilical cord blood transplants.
• The median follow-up for survivors was 7.2 years, with an overall 5-year OS of 67.4%.
• No statistically significant difference in 5-year OS was observed across center volume categories (p = 0.85).

Clinical Implications

These findings suggest that pediatric allogeneic HCT outcomes are comparable across centers regardless of transplant volume, indicating that smaller centers can achieve survival rates similar to high-volume institutions. This supports the feasibility of providing pediatric HCT care in diverse settings without compromising outcomes. Focus on optimizing conditioning regimens, donor matching, and supportive care may be more critical than center volume alone.

Conclusion

In this large national cohort, transplant center volume did not significantly influence 5-year overall survival after pediatric allogeneic HCT. These results highlight the importance of standardized care practices across centers to ensure optimal outcomes for pediatric patients.

References

1. Japanese Society for Transplantation and Cellular Therapy & Japanese Data Center for Hematopoietic Cell Transplantation 2020 -- Transplant Registry Unified Management Program
2. Kanda et al. 2020 -- Statistical Methods for Hematopoietic Cell Transplantation Outcomes