Late non-relapse mortality among adult autologous stem cell transplant recipients: a nation-wide analysis of 1,482 patients transplanted in 1990-2003.
Data on the incidence and causes of late (>100 d) non-relapse mortality (NRM) in autologous stem cell transplant (ASCT) recipients is limited. We have analysed NRM in a cohort of 1,482 adult patients who received ASCT in 1990-2003 in six Finnish transplant centres. The most common diagnoses included non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (n = 132); Hodgkin's lymphoma (HL) (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). Until September 2005, 646 patients (44%) have died. Late NRM was observed in 68 patients (4.6% of ASCT recipients; 11% of all deaths). There were 38 males and 30 females with a median age of 58 yr (20-69) at the time of ASCT. The median time to NRM was 27 months from ASCT (3-112). The risk of NRM was highest in patients with CLL (9.5%) and those with HL (8.1%) followed by MM and NHL (4.9% and 4.8%, respectively). The risk of late NRM was comparable in patients who received total body irradiation (TBI) and those who received chemotherapy-only regimens (6.7% vs. 4.3%). Another malignancy was the most common cause of late NRM (24 patients, 35% of late NRM). Twelve patients (0.8% of ASCT recipients) have died due to secondary haematological malignancy. Altogether 22 patients (32% of late NRM) died from infectious causes. Malignancies and late infections are important causes of NRM after ASCT. These facts point out the importance of prolonged follow-up in ASCT recipients.
Jantunen
E
E
Department of Medicine, Kuopio University Hospital, Kuopio, Finland. esa.jantunen@kuh.fi
Itälä
M
M
Siitonen
T
T
Koivunen
E
E
Leppä
S
S
Juvonen
E
E
Kuittinen
O
O
Lehtinen
T
T
Koistinen
P
P
Nyman
H
H
Nousiainen
T
T
Volin
L
L
Remes
K
K
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007239:Infections / Q000401:mortality; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000601:surgery; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000601:surgery; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000401:mortality; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D019172:Transplantation Conditioning / Q000401:mortality; D014182:Transplantation, Autologous / Q000401:mortality / Q000706:statistics & numerical data; D014916:Whole-Body Irradiation / Q000009:adverse effects