title: Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study.
abstract: We assessed late mortality in 854 individuals who had survived 2 or more years after autologous hematopoietic cell transplantation (HCT) for hematologic malignancies. Median age at HCT was 36.5 years, and median length of follow-up was 7.6 years. Overall survival was 68.8% +/- 1.8% at 10 years, and the cohort was at a 13-fold increased risk for late death (standardized mortality ratio [SMR] = 13.0) when compared with the general population. Mortality rates approached those of the general population after 10 years among patients at standard risk for relapse at HCT (SMR = 1.1) and in patients undergoing transplantation for acute myeloid leukemia (AML; SMR = 0.9). Relapse of primary disease (56%) and subsequent malignancies (25%) were leading causes of late death. Relapse-related mortality was increased among patients with Hodgkin disease (HD; relative risk [RR] = 3.6), non-Hodgkin lymphoma (NHL; RR = 2.1), and acute lymphoblastic leukemia (ALL; RR = 6.5). Total body irradiation (RR = 0.6) provided a protective effect. Nonrelapse-related mortality was increased after carmustine (RR = 2.3) and with use of peripheral blood stem cells (RR = 2.4). Survivors were more likely to report difficulty in holding jobs (RR = 9.4) and in obtaining health (RR = 7.7) or life insurance (RR = 8.4) when compared with siblings. Although mortality rates approach that of the general population after 10 years in certain subgroups, long-term survivors of autologous HCT continue to face challenges affecting their health and well-being.
authors.affiliation: City of Hope Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000, USA. sbhatia@coh.org
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.forename: Andrea
authors.initials: A
authors.lastname: Carter
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Marcia
authors.initials: M
authors.lastname: Grant
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Henry
authors.initials: H
authors.lastname: Fung
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Philip B
authors.initials: PB
authors.lastname: McGlave
authors.forename: Auayporn
authors.initials: A
authors.lastname: Nademanee
authors.forename: Norma K C
authors.initials: NK
authors.lastname: Ramsay
authors.forename: Anthony
authors.initials: A
authors.lastname: Stein
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011788:Quality of Life; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors; D014182:Transplantation, Autologous