title: Outcome and risk factors for late-onset complications 24 months beyond allogeneic hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  The aim of this retrospective study was to assess the incidence of late complications occurring ≥2 years after allogeneic hematopoietic stem cell transplantation (HSCT) for malignant diseases using a T-cell depletion strategy.
  
  
  METHODS
  Between 1984 and 2004, 142 patients were eligible for the study. Total body irradiation (TBI) was carried out in 85% of the patients and T-cell depletion in 84%.
  
  
  RESULTS
  Non-relapse mortality (NRM) was 3% (95% CI 0-11) at 10 years, and serious late events affected a substantial number of patients. The cumulative incidence (CI) of chronic graft-versus-host disease (cGvHD) was 30% (95% CI 23-40), and that of infectious complications was 17% (95% CI 11-23). Multivariate analysis showed a higher risk for late complications in patients with cGvHD (HR 1.9, 95% CI 1.2-3.2, P=0.011) and patients receiving methylprednisolone during conditioning (HR 1.9, 95% CI 1.1-3.3, P=0.019 1), patients with cGvHD also having a higher risk for NRM (HR 13.2, 95% CI 1.2-143, P=0.03), as well as those receiving steroids for >3 months (HR 40.3, 95% CI 2.3-718, P=0.02) and those receiving antithymocyte globulin (HR 9.6, 95% CI 0.8-68, P=0.024).
  
  
  CONCLUSIONS
  A significant proportion of long-term survivors of HSCT had late complications. cGvHD remained an important risk factor for late complications despite T-cell depletion resulting in immunosuppression and infectious complications.
authors.affiliation: Division of Radiation Oncology, University Hospital, Geneva, Switzerland.
authors.forename: Sabine
authors.initials: S
authors.lastname: Bieri
authors.forename: Eddy
authors.initials: E
authors.lastname: Roosnek
authors.forename: Hulya
authors.initials: H
authors.lastname: Ozsahin
authors.forename: Saadia
authors.initials: S
authors.lastname: Huguet
authors.forename: Marc
authors.initials: M
authors.lastname: Ansari
authors.forename: Andrea
authors.initials: A
authors.lastname: Trombetti
authors.forename: Claudine
authors.initials: C
authors.lastname: Helg
authors.forename: Bernard
authors.initials: B
authors.lastname: Chapuis
authors.forename: Raymond
authors.initials: R
authors.lastname: Miralbell
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Yves
authors.initials: Y
authors.lastname: Chalandon
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005128:Eye Diseases / Q000209:etiology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007239:Infections / Q000209:etiology; D008212:Lymphocyte Depletion; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D016609:Neoplasms, Second Primary / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D008775:Methylprednisolone