Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study.
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.
Bhatia
Smita
S
City of Hope Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000, USA. sbhatia@coh.org
Robison
Leslie L
LL
Francisco
Liton
L
Carter
Andrea
A
Liu
Yan
Y
Grant
Marcia
M
Baker
K Scott
KS
Fung
Henry
H
Gurney
James G
JG
McGlave
Philip B
PB
Nademanee
Auayporn
A
Ramsay
Norma K C
NK
Stein
Anthony
A
Weisdorf
Daniel J
DJ
Forman
Stephen J
SJ
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