这项全国性研究回顾性研究了同种异体造血干细胞移植 (allo-HSCT) 治疗成人 B 细胞急性淋巴细胞白血病的中心效应。队列分析分为费城染色体（Ph）阳性和阴性病例。根据每个机构的异基因造血干细胞移植数量，将患者分为低容量组和高容量组。主要终点是 5 年总生存期 (OS)。这项研究包括 1156 例低量和 1329 例高量 Ph 阴性病例以及 855 例低量和 926 例高量 Ph 阳性病例。在 Ph 阴性病例中，高容量中心的 5 年 OS 显着较高，为 52.7%（95% 置信区间 [CI]：49.9-55.5），而低容量中心的 5 年 OS 为 46.8%（95% CI：43.8-49.7） -体积中心（P < 0.01）。多变量分析确定高容量是有利的预后因素（风险比 [HR]：0.81 [95% CI：0.72-0.92]，P < 0.01）。 Ph阴性病例的亚组分析显示，年龄≥40岁的患者（HR：0.72，95％CI：0.61-0.86，P < 0.01）和接受脐带血移植的患者（HR：0.62，95）中心效应更为明显。 % CI：0.48-0.79，P < 0.01）。在 Ph 阳性病例中，高容量中心和低容量中心之间的 5 年 OS 没有观察到显着差异（59.5% [95% CI: 56.2-62.7] vs. 54.9% [95% CI: 51.3-58.3]， P = 0.054）。在多变量分析中，中心体积并未成为重要的预后指标。这项研究显示了 Ph 阴性病例的中心效应，但对 Ph 阳性病例的生存没有影响，强调了 B 细胞急性淋巴细胞白血病同种异体造血干细胞移植中中心效应的异质性。移植中心之间的合作和进一步验证对于改善结果至关重要。版权所有 © 2024 国际细胞学会

This nationwide study retrospectively examined the center effect on allogeneic hematopoietic stem cell transplantation (allo-HSCT) for adult B-cell acute lymphoblastic leukemia. The cohort analyses were separated into Philadelphia chromosome (Ph)-positive and -negative cases. The patients were divided into low- and high-volume groups according to the number of allo-HSCTs at each facility. The primary endpoint was 5-year overall survival (OS). This study included 1156 low-volume and 1329 high-volume Ph-negative and 855 low-volume and 926 high-volume Ph-positive cases. In Ph-negative cases, 5-year OS was significantly higher in the high-volume centers at 52.7% (95% confidence interval [CI]: 49.9-55.5) versus 46.8% (95% CI: 43.8-49.7) for the low-volume centers (P < 0.01). Multivariate analysis identified high volume as a favorable prognostic factor (hazard ratio [HR]: 0.81 [95% CI: 0.72-0.92], P < 0.01). Subgroup analysis in Ph-negative cases revealed that the center effects were more evident in patients aged ≥40 years (HR: 0.72, 95% CI: 0.61-0.86, P < 0.01) and those receiving cord blood transplantation (HR: 0.62, 95% CI: 0.48-0.79, P < 0.01). In Ph-positive cases, no significant difference was observed between the high and low-volume centers for 5-year OS (59.5% [95% CI: 56.2-62.7] vs. 54.9% [95% CI: 51.3-58.3], P = 0.054). In multivariate analysis, center volume did not emerge as a significant prognostic indicator. This study showed center effects on survival in Ph-negative but not in Ph-positive cases, highlighting the heterogeneity of the center effect in allo-HSCT for B-cell acute lymphoblastic leukemia. Collaborative efforts among transplant centers and further validation are essential to improve outcomes.Copyright © 2024 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.