Comparative data on alternative donor platforms in adolescent and young adult (AYA) allogeneic hematopoietic cell transplantation (HCT) are limited. We conducted a nationwide retrospective registry study in Japan comparing unrelated umbilical cord blood transplantation (UCBT), haploidentical transplantation without post-transplant cyclophosphamide (non-PTCy-haplo), and PTCy-based haploidentical transplantation (PTCy-haplo). The study included 458 patients aged 16-25 years (UCBT, n = 101; non-PTCy-haplo, n = 132; PTCy-haplo, n = 225). The main endpoints were overall survival (OS) and relapse-free survival (RFS); relapse, non-relapse mortality (NRM), graft-versus-host disease (GVHD), and engraftment were also evaluated. UCBT showed the most favorable survival. In multivariable analyses, non-PTCy-haplo was associated with inferior OS and RFS, higher NRM, and a higher incidence of grade II-IV acute GVHD than UCBT. PTCy-haplo was associated with inferior OS versus UCBT but showed no significant differences in RFS, relapse, NRM, acute GVHD, or chronic GVHD. Both haploidentical platforms showed faster neutrophil engraftment than UCBT, and PTCy-haplo also showed faster platelet engraftment. Sensitivity analyses restricted to malignant disease and stratified by conditioning intensity supported these findings. In this AYA cohort, UCBT was associated with the most favorable survival, non-PTCy-haplo showed consistently inferior outcomes, and PTCy-haplo remained a practical alternative when rapid donor availability and early hematopoietic recovery are prioritized.

Effective risk stratification is vital for donor selection and treatment strategies in allogeneic hematopoietic stem cell transplantation (HSCT). We developed a prediction model for mid- to long-term outcomes after HSCT using a stacked ensemble model (SEM). Using data from the Japanese Transplant Registry Unified Management Program, we analyzed 14,430 patients alive without chronic GVHD (cGVHD) or relapse on day 100 after their first HSCT for hematologic malignancies between 2010 and 2018, predicting 24-month outcomes from pretransplant variables and posttransplant acute GVHD (aGVHD) information, including its treatment, accrued by days 30, 60, and 100. Data were randomly divided into training (80%) and validation (20%) sets, with 14 pretransplant risk factors as input variables. SEM achieved the highest C-index across evaluated endpoints, cGVHD, non-relapse mortality (NRM), and all-cause mortality (ACM), significantly exceeding the weaker learners for all endpoints and, using pretransplant factors, the strongest learner for NRM and ACM as well (both p=0.01), with a smaller, non-significant margin for cGVHD (C-index for cGVHD/NRM/ACM—SEM: 0.574/0.652/0.642, Cox-PH: 0.553/0.635/0.615, Random Survival Forest: 0.564/0.638/0.613, XGBoost: 0.556/0.633/0.627, Dynamic-DeepHit: 0.508/0.607/0.564). The C-index increased as posttransplant aGVHD information accrued (day 30: 0.581/0.655/0.649; day 60: 0.602/0.688/0.656; day 100: 0.606/0.696/0.664). Grade III to IV aGVHD showed predictive contribution to NRM, ultimately impacting ACM. Our SEM-based model offers a useful framework for predicting post-HSCT outcomes and highlights the critical impact of early aGVHD events on long-term prognosis.

OBJECTIVES:Bacteraemia and cytomegalovirus (CMV) infection are major infectious complications after allogeneic haematopoietic cell transplantation (HCT). However, their bidirectional relationship, particularly in the setting of letermovir (LTV) prophylaxis, remains unclear. We investigated the bidirectional associations between bacteraemia and CMV infection and their impact on transplantation outcomes. We also evaluated the effect of LTV prophylaxis on these associations. METHODS:Using a nationwide Japanese transplant registry database, we analysed 23,841 patients who underwent their first allogeneic HCT between 2008 and 2022. Multivariable Cox proportional hazards models with time-dependent covariates were used to evaluate bidirectional associations between bacteraemia and clinically significant CMV infection (csCMVi). RESULTS:csCMVi was associated with an increased risk of subsequent bacteraemia (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.33-1.64), with a stronger association among patients in the LTV group (aHR, 2.59; 95% CI, 1.87-3.60) than among those in the no-LTV group (aHR, 1.30; 95% CI, 1.16-1.46). Conversely, bacteraemia was modestly associated with an increased risk of csCMVi overall (aHR, 1.06; 95% CI, 1.01-1.11), but this association was observed only in the LTV group (aHR, 1.61; 95% CI, 1.40-1.85). These bidirectional associations were consistent in the LTV era and in patients without grade II-IV acute graft-versus-host disease. The findings were robust in sensitivity analyses, including landmark and propensity score-matched analyses. In propensity score-matched cohorts, both bacteraemia and csCMVi were associated with higher nonrelapse mortality (NRM; defined as death without relapse of the underlying malignancy) and inferior overall survival (OS), regardless of LTV use. CONCLUSIONS:Bacteraemia and csCMVi were bidirectionally associated after allogeneic HCT, particularly in the LTV group. Both bacteraemia and csCMVi were consistently associated with higher NRM and inferior OS, regardless of LTV prophylaxis. These findings highlight the need for integrated infection management strategies, particularly in the LTV era.

Donor selection in allogeneic haematopoietic stem cell transplantation (allo-HSCT) requires balancing donor safety and recipient survival. We aimed to identify dual-association donor factors (DADFs)-donor characteristics associated with both increased serious adverse events (SAEs) and inferior patient survival-using umbilical cord blood (UCB) as a donor-safety benchmark. This nationwide retrospective cohort study analysed Japanese registry data (2013-2022) including 22 892 donors and 29 559 recipients. Logistic regression identified donor SAE risk factors, while patient outcomes were evaluated using inverse probability of treatment weighting (IPTW)-adjusted Cox models with UCB as reference. Propensity score matching (PSM) compared UCB with older donor haploidentical transplantation using post-transplant cyclophosphamide (OD-PTCy-Haplo). Among donors, 93 (0.41%) experienced an SAE. Older donor age and female sex were independent risk factors for SAE. In IPTW-adjusted analyses, allo-HSCT from older haploidentical donors was associated with inferior overall survival (OS) and relapse-free survival (RFS) compared with UCB. In PSM analyses of elderly high-risk recipients, OD-PTCy-Haplo resulted in significantly worse OS and RFS than UCB. Older donor age emerged as a donor characteristic associated with increased donor SAE risk and inferior patient survival, particularly in haploidentical transplantation. UCB may offer a more favourable balance between donor safety and patient outcomes in selected high-risk settings.

Abstract This phase 2 clinical study evaluated the efficacy and safety of post–allogeneic hematopoietic stem cell transplantation maintenance cancer immunotherapy using 2 Wilms tumor 1 (WT1) peptide vaccines, MCI, for pediatric refractory acute leukemias. Each of 17 patients (median age, 8.3 years [range, 2-18]) was intradermally injected with either of the vaccines. The 3-year overall survival (OS) rate (primary end point) was 70.6% (95% confidence interval [CI], 43.1-86.6); this rate was >30%, a historical control benchmark, and was attributable to the fact that 12 clinical responders, who sustained complete remission at year 1 after the initiation of vaccination, had a high 3-year OS rate of 91.7% (95% CI, 53.9-98.7). WT1-specific cytotoxic T-cell (CTL) frequency in peripheral blood (PB) from all 12 clinical responders increased significantly after vaccination, reaching the maximum by week 12 of vaccination (before, 0.25% ± 0.08%; after, 1.07% ± 0.24%; P< .001), whereas WT1-specific CTL frequency in PB from clinical nonresponders remained unchanged after vaccination (before, 0.12% ± 0.2%; after, 0.20% ± 0.25%; P = .424). The estimated 3-year OS rate was significantly higher for 11 immune responders (who showed a ≥1.455-fold increase from the baseline value: 90.9%) than for 5 immune nonresponders (40.0%; P = .027). Elevated WT1-specific CTL frequency in the PB before vaccination predicted the subsequent favorable patient prognosis. No patient discontinued treatment because of MCI. Adverse events including graft-versus-host disease were manageable. MCI was suggested to be very effective and safe for pediatric patients with refractory acute leukemias, indicating its potential to improve their survival through relapse prevention. This trial was registered at the University Hospital Medical Information Network Clinical Trials Registry as #UMIN000005319.

Down syndrome-associated acute lymphoblastic leukaemia (DS-ALL) is associated with inferior outcomes compared with non-DS-ALL; however, data on haematopoietic stem cell transplantation (HSCT) in DS-ALL remain limited. We analysed nationwide data of patients aged <30 years with B-cell precursor ALL who underwent first allogeneic HSCT between 2000 and 2022 in Japan. In total, 56 patients with DS-ALL and 3873 with non-DS-ALL were identified. The incidences of neutrophil engraftment, grade II-IV acute graft-versus-host disease and chronic graft-versus-host disease were comparable between groups. The 4-year event-free survival (EFS) was lower in DS-ALL than in non-DS-ALL (40.3% vs. 55.2%), but was similar when stratified by disease status at HSCT. The 4-year EFS rates in first and second complete remission (CR) were 62.7% and 48.2% in DS-ALL and 69.5% and 56.0% in non-DS-ALL respectively. Relapse, rather than non-relapse mortality (NRM), was the leading cause of treatment failure in DS-ALL. Among patients with DS-ALL undergoing HSCT in CR1/2, myeloablative conditioning (MAC) showed a trend towards superior EFS compared with reduced-intensity conditioning (RIC), which was associated with a higher incidence of NRM. Accordingly, patients in CR1/2 who are unable to tolerate MAC are considered good candidates for emerging novel therapies rather than RIC-HSCT.

In allogeneic haematopoietic stem cell transplantation (allo-HSCT) for genetic disorders (GDs), predicting outcomes using the currently used myeloablative/reduced-intensity conditioning classification is challenging. We examined the utility of the transplant conditioning intensity (TCI) score in allo-HSCT for GDs. We retrospectively analysed 1077 patients who underwent first allo-HSCT for GDs between 1987 and 2018. While no significant difference was observed in 3-year non-relapse mortality (NRM) between the myeloablative and reduced-intensity conditioning group, 3-year NRM in the TCI score ≥4.0 (TCI-high) group (17.3%) was higher than that in the TCI score 0.5-3.5 (TCI-low/intermediate) group (11.6%, p = 0.013). Multivariate analysis identified a high TCI score as a significant factor for NRM (HR 1.56, p = 0.011). Infection-related mortalities were more prevalent in the TCI-high group (7.9%) compared with the TCI-low/intermediate group (3.2%). In contrast, patients in the TCI-high group achieved a significantly higher rate of complete donor chimerism (71.7%) than those in the TCI-low/intermediate group (62.2%, p = 0.022). TCI score is a valuable tool for predicting outcomes after allo-HSCT for GDs as well as for guiding the selection of conditioning regimens tailored to the unique characteristics of GDs.

As a second-line treatment for first-line steroid-refractory acute GVHD, ruxolitinib was proven to be significantly more effective than control therapies (nine commonly used therapy options) in a prospective, randomized trial. However, it could sometimes be difficult to administer ruxolitinib for patients with cytopenia or who have difficulty taking it orally regularly. The present retrospective study compared the outcomes of second-line mesenchymal stromal cell (MSC) and antithymocyte globulin (ATG) therapies following first-line steroid therapy for acute GVHD. Clinical data for the total 1120 patients who received MSC (n = 777) and ATG (n = 343) as second-line therapy following first-line steroid therapy for acute GVHD from 2016 to 2022, when both therapies were covered by health insurance in Japan, were extracted from Japanese stem cell transplantation registry data. Overall response rates (ORRs) on day 28 of the MSC and ATG therapies were 62.7% and 51.0%, respectively (multivariate analysis: odds ratio, 1.56; P = 0.001). ORRs for skin, liver, and gastrointestinal tract acute GVHD were 66.3% versus 57.5% (1.43, P = 0.063), 33.1% versus 25.7% (1.18, P = 0.636), and 66.3% versus 49.8% (1.96, P < 0.001), respectively. The incidences of invasive fungal infection and viral infection within the first 100 days after the start of second-line therapy were 3.9% versus 8.2% (Fisher's exact test: P = 0.005) and 13.4% versus 25.1% (P < 0.001), respectively. However, non-relapse mortality, the relapse rate, and overall survival did not differ between MSC and ATG therapies. Furthermore, the propensity score-matched analysis yielded results consistent with the findings described above. In conclusion, this retrospective study demonstrated that the ORR based on whole body assessment and the ORR based on gastrointestinal tract stage assessment were both significantly higher with MSC therapy than with ATG therapy. However, prospective, randomized, controlled trials are necessary for a more accurate comparison.

In this Japanese registry-based analysis of 9105 adult patients with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation, a marked difference in survival was observed based on platelet levels: ≤ 20 × 109/L, 20-50 × 109/L, and > 50 × 109/L. The number of patients with thrombocytopenia receiving cord blood (CB, 39%) was significantly larger than those receiving unrelated bone marrow (uBM, 17%) on Day 50 (p < 0.001); however, this difference disappeared on Day 100 posttransplantation (both 11%, p = 0.4).

The SARS-CoV-2 pandemic disrupted healthcare systems worldwide, particularly affecting hematopoietic stem cell transplantation (HSCT) activities. Understanding the impact of the SARS-CoV-2 pandemic on transplant practices, especially in Japan, where cord blood transplantation (CBT) is prevalent, is crucial. A total of 40,444 allogeneic HSCT cases in Japan between 2011 and 2021 were examined using an interrupted time series analysis to assess the impact of COVID-19 on CBT utilization. Following the SARS-CoV-2 pandemic, CBT cases demonstrated a significant increase (11.06 [95% confidence interval (CI): 1.87 to 20.25] cases per month), whereas bone marrow transplantation cases decreased, by 10.74 cases per month (95% CI, −19.84 to −1.63 cases per month). Total HSCT cases remained stable with a level change of 5.47 cases per month (95% CI, −10.07 to 21.01 cases per month) and a trend change of −1.11 cases per month (95% CI, −2.22 to 0.004 cases per month). The interrupted time series analysis showed significantly increased CBT cases in Japan, highlighting its crucial role as an alternative transplant source during the pandemic. CBT offset the impact of the decrease in bone marrow transplantation and contributed to the maintenance of HSCT activity in Japan during the unprecedented crisis.

Prophylactic, diagnostic, and treatment strategies for acute graft-versus-host disease (aGVHD) may vary across medical centers and physicians. We aimed to investigate the relationship between center volume and the incidence and outcomes of aGVHD. This retrospective study included 28,786 patients who underwent their first hematopoietic stem cell transplantation (HSCT) (entire cohort) and 9498 patients who developed grade II-IV aGVHD (aGVHD cohort). Data were categorized into quartiles (very low, low, high, and very high) based on the number of HSCTs the treating center performed during the study period. We assessed the incidence of aGVHD using the entire cohort and overall survival (OS) using the aGVHD cohort. Higher center volume was associated with a higher incidence of grade II-IV aGVHD than very low center volume, with an adjusted hazard ratio of 1.07-1.11. Conversely, center volume was not associated with the incidence of grade III-IV aGVHD. OS after development of aGVHD was better in the higher center volume group than the very low-volume group, with an adjusted hazard ratio of 0.81-0.89. A very low-volume center was associated with a lower incidence of grade II-IV aGVHD in patients with allogeneic HSCT and poor survival in patients with aGVHD.

We evaluated the impact of center volume on outcomes in patients with B-cell acute lymphoblastic leukemia following their second allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our cohort included 299 patients with relapse and 68 patients with graft failure after their first allo-HSCT between 2003 and 2017. Patients were stratified into low- and high-volume groups based on the number of allo-HSCT performed at each center. The primary endpoint was 5-year overall survival (OS) following the second allo-HSCT. In the relapse cohort, the high-volume group demonstrated significantly better 5-year OS (21.1% vs 13.6%, P = 0.0062) and progression-free survival (16.1% vs 10.6%, P = 0.010). Multivariate analysis showed that high-volume group was a favorable factor for OS (hazard ratio [HR]: 0.72, 95% confidence interval [CI]: 0.56-0.94, P = 0.016). This survival benefit was consistent in both Philadelphia chromosome-negative (HR: 0.71, 95% CI: 0.51-0.99, P = 0.042) and positive (HR: 0.61, 95% CI: 0.39-0.95, P = 0.030) subcohorts. In the graft failure cohort, the high-volume group showed a trend toward better 5-year OS (41.6% vs 24.4%, P = 0.098) and lower 5-year nonrelapse mortality (NRM) (55.9% vs 75.6%, P = 0.067). Multivariate analysis confirmed the protective effect of the high-volume group on NRM (HR: 0.55, 95% CI: 0.30-0.99, P = 0.044). Our findings demonstrate that center volume significantly impacts outcomes after the second allo-HSCT regardless of indication, highlighting the need for inter-center collaboration and standardized management strategies for this high-risk population.

Inflammatory bowel disease (IBD) is a phenotype of patients with inborn errors of immunity (IEI). Allogeneic hematopoietic cell transplantation (HCT) is an established curative treatment for IEI; however, the effect of IBD on HCT outcomes is unclear. We evaluated the impact of IBD on post-HCT prognosis in pediatric patients with IEI. We used the Japanese transplant registry database to retrospectively analyze the medical records of 625 patients with pediatric IEI who underwent allogeneic HCT between 2007 and 2022 to evaluate the clinical impact of IBD on these patients. Sixty-six (10.6%) patients had concurrent IBD before HCT. Compared with patients without IBD, those with IBD did not show inferior overall survival, transplant-related mortality, or neutrophil and platelet engraftment. Moreover, no significant differences were observed in the incidence of acute or chronic graft-versus-host disease (GVHD) between the two groups. However, the IBD group had a higher incidence of acute gastrointestinal GVHD. These findings remained consistent even after propensity score matching, accounting for the identified risk factors, including age at HCT, performance status, total HCT-specific comorbidity index score, HLA mismatch, era of HCT, and underlying disease classification. IBD has a limited effect on HCT outcomes in patients with pediatric IEI, despite the higher incidence of acute gastrointestinal GVHD. Nevertheless, in this study, we included patients with heterogeneous and complex disease backgrounds, indicating the need for further investigation to confirm the findings.

Few reports exist on the transplant outcomes of Epstein–Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH). This nationwide survey evaluated the clinical outcomes of pediatric patients with EBV-HLH who underwent allogeneic HCT. Data from 32 pediatric patients with EBV-HLH who underwent their first allogeneic HCT between 2000 and 2020 were reviewed retrospectively. Of the 32 patients, 12 had a performance status of 3–4 and 8 had multiple organ dysfunction. The cumulative incidence of engraftment on day 30 was 53.1

The impact of center volume on outcomes in pediatric hematopoietic cell transplantation (HCT) is not well established. We retrospectively analyzed data from a nationwide registry, including 6966 pediatric patients who underwent their first allogeneic HCT at 123 centers in Japan between 2001 and 2020. Centers were categorized by transplant volume as low volume centers (C1, the smallest number of transplantation), medium-low volume centers (C2), medium-high volume centers (C3), and high volume centers (C4, the greatest number of transplantation), and outcomes were compared across these categories. The analysis revealed no statistically significant differences in HCT outcomes among center categories. The 5-year OS by center category was 66.8% (95% CI 64.4–69.0%) for C1, 66.8% (95% CI 64.5–69.0%) for C2, 67.9% (95% CI 65.6–70.2%) for C3, and 68.3% (95% CI 65.9–70.6%) for C4. These results were consistent even when analysis was restricted to malignant and nonmalignant diseases. Our findings suggest that, unlike in adult HCT, outcomes for pediatric HCT are not significantly affected by center volume. These results indicate the consistent quality of care across centers, supporting the accessibility of HCT at various institutions for pediatric patients.

Introduction The biological heterogeneity of human leukocyte antigen (HLA) molecules, including differences in B-leader peptides and peptide-binding motifs, has been increasingly recognized as a critical determinant of posttransplant immune responses. Subclassification of mismatched HLA alleles based on these molecular features has been reported to predict outcomes of mismatched allogeneic hematopoietic cell transplantation (allo-HCT). Protein language models (pLMs), which adopt architectures similar to large language models, can embed protein sequences into latent representations that are thought to capture their biochemical and structural properties. In this study, we aimed to identify HLA features associated with the development of acute graft-versus-host disease (aGVHD) in HLA-mismatched allo-HCT by leveraging latent representations generated by a pLM. Methods We retrospectively analyzed the clinical outcomes of patients (age ≥16 years) with hematological malignancies who underwent allo-HCT from unrelated donors in Japan between 2000 and 2022, with a one-allele mismatch (7/8 match) in the graft-versus-host direction at the HLA-A, -B, -C, and -DRB1 loci. Patient data were obtained from the Japanese Society for Transplantation and Cellular Therapy and the Japanese Data Center for Hematopoietic Cell Transplantation, using the Transplant Registry Unified Management Program. This retrospective study was designed in accordance with the Declaration of Helsinki and approved by the Ethical Committee of Osaka Metropolitan University Graduate School of Medicine (Osaka, Japan) (identification number 2024-167). HLA sequences were embedded using the Evolutionary Scale Modeling 2 (ESM2-15B) model, which is one of the largest pLMs. The dataset was randomly split into a training set (80%) and test set (20%). To predict the incidence of aGVHD, we constructed an attention mechanism-based neural network architecture that compressed HLA embeddings from each donor-recipient pair into one-dimensional continuous variables. We employed the nnet survival framework, a deep learning-based survival analysis model, using the incidence of grade II–IV acute GVHD as the outcome label. This model incorporates both HLA embeddings and clinical covariates as the inputs. The model performance was evaluated using time-dependent receiver operating characteristic (ROC) curves. For model interpretability, the SHAP values and attention maps were analyzed. Additionally, the clinical significance of HLA latent features was evaluated using cause-specific analysis with a Cox proportional hazards model. Results In total, 6,084 patients were included in the analysis, with 4,867 used for model training and 1,217 for testing. The area under the ROC curve (AUC) for predicting grade II–IV and grade III–IV aGVHD on day 30 was 0.604 and 0.622, respectively. On day 100, the AUC was 0.538 for grades II–IV aGVHD and 0.545 for grades III–IV aGVHD. The attention map consistently highlights the HLA peptide-binding pocket region, suggesting its biological relevance. According to SHAP values, HLA embedding was ranked as the fourth most important predictor among all 30 covariates, following conditioning intensity, presence or absence of ATG, and whether the disease was AML. In the cause-specific Cox proportional hazards model adjusted for established risk factors for aGVHD, the one-dimensional paired HLA embedding feature was not significantly associated with the incidence of grade II–IV aGVHD (hazard ratio [HR], 0.74; 95% confidence interval [CI]: 0.46–1.22, p = 0.24). In contrast, a significant association was observed for grade III–IV aGVHD (HR, 2.47; 95% CI: 1.01–6.03, p = 0.048). Conclusion Latent HLA representations derived from pLM successfully contributed to the prediction of severe aGVHD in HLA-mismatched allo-HCT. Attention-based interpretability suggests that the diversity within the HLA peptide-binding pocket may play a pivotal role in the immunopathogenesis of aGVHD. This approach offers a novel data-driven strategy for evaluating the immunogenetic risk of allo-HCT.

Chronic graft-versus-host disease (cGVHD) is a complication of allogeneic hematopoietic stem cell transplantation (HSCT), negatively impacting quality of life (QoL) and increasing the risk of death. Complexity in cGVHD diagnosis and treatment causes significant variations in cGVHD management strategies across medical centers and physicians despite the existence of published guidelines. Thus, we hypothesized that center volume is associated with cGVHD incidence and outcomes after cGVHD develops. This study aimed to evaluate the effect of center volume on the incidence of cGVHD in patients who underwent HSCT and outcomes in patients with cGVHD. Our retrospective study included 28,786 patients who underwent their first HSCT (overall cohort) and 7664 who developed cGVHD (cGVHD cohort). We categorized institutions into quartiles (very low, low, high, and very high) using the number of HSCTs performed during the study period. We assessed cGVHD incidence in overall cohort and overall survival (OS) in cGVHD cohort. The very high-volume group showed significantly higher cGVHD incidence (adjusted hazard ratio [HR], 1.38; 95% confidence interval [CI]: 1.30 to 1.46) compared to the very low-volume group. However, the cGVHD incidence was similar among very low-, low- and high-volume groups. Low, high, and very high-volume groups showed significantly higher OS with adjusted HRs of 0.83 (95% CI: 0.73 to 0.94), 0.69 (95% CI: 0.61 to 0.79), and 0.68 (95% CI: 0.60 to 0.76), respectively, compared with the very low-volume group. In conclusion, we revealed a higher incidence of cGVHD in the very high-volume group and a poor survival outcome in the very low-volume group in patients with cGVHD.

The Joint Committee for Nationwide Survey on colorectal liver metastasis (CRLM) was established to improve treatment outcomes in patients with CRLM. The aim of this study was to evaluate the transition in the characteristics and treatment strategies of patients with CRLM and to analyze the prognostic factors. The data of 5085 patients newly diagnosed between 2013 and 2017 were compared with those of 3820 patients from 2005 and 2007. In patients who underwent hepatectomy (n = 2759 and 2163), the number of CRLMs was significantly higher and in the 2013-2017 data than in the 2005-2007 data (median 2 vs. 1; p = .005). Overall survival (OS) rates after diagnosis of CRLM after hepatectomy were better in the 2013-2017 data than that in the 2005-2007 data (5-year OS, 62.4% vs. 56.7%, p < .001). Recurrence-free survival (RFS) after hepatectomy was comparable between the groups (5-year RFS, 30.5% vs. 30.7%; p = .068). Multivariate analyses identified age at diagnosis of CRLM >= 70 years, lymph node metastasis of primary lesion, preoperative carbohydrate antigen (CA) 19-9 value >100 U/mL, number of CRLM 2-4, and R2 resection as independent predictors of OS. Synchronous CRLM, concomitant extrahepatic metastasis, lymphatic invasion, lymph node metastasis of primary lesion, preoperative CA19-9 value >100 U/mL, number of CRLM 5-, and nonlaparoscopic approach were selected as that of RFS. Despite having a higher prevalence of advanced stage CRLM in the 2013-2017 patient population compared to the 2005-2007 cohort, prognostic outcomes demonstrably improved in the later period.