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High-dose chemotherapy with or without radiation therapy followed by hematopoietic stem cell transplantation (HSCT) is widely used to treat a variety of cancers and other diseases. These stem cells can be collected from bone marrow, peripheral blood, or umbilical cord blood. HSCT carries high risks ranging from infection and bleeding to organ toxicity and death. Patients who undergo HSCT at a center that performs a high volume of transplants are less likely to die or fail treatment than similar patients treated at low-volume transplant centers, according to a review that was supported in part by the Agency for Healthcare Research and Quality (HS13046).
Researchers at the Medical College of Wisconsin examined studies on the association between treatment center (especially HSCT center) factors and clinical outcomes in general medicine and surgery. They found an association between survival and HSCT volume at transplant centers. One study found that patients transplanted at centers performing an average of five or fewer transplants per year had a 1.5-fold greater risk of experiencing treatment-related death and a 1.4-fold greater risk of treatment failure than patients treated at centers performing more than five transplants per year.
These relative risks equated to a 10 percent difference in treatment-related deaths and an 8 percent difference in treatment failure at 2 years post-transplant. Other studies found similar results. For instance, an 8-year study found that treatment-related mortality was significantly lower in high-volume centers that performed at least 352 transplants during the 8-year study period (44 per year). Similarly, high-volume centers were found to have a 30 percent lower relative risk of treatment failure. However, high procedure volume was not consistently defined across studies. The researchers also caution that none of the studies examined other center characteristics that might affect outcomes, such as staff experience and workload and transplant unit resources and programs.
More details are in "Transplant center characteristics and clinical outcomes after hematopoietic stem cell transplantation: What do we know?" by F.R. Loberiza Jr., D.S. Serna, M.M. Horowitz, and J.D. Rizzo, in Bone Marrow Transplantation 31, pp. 417-421.
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