title: Increase of suicide and accidental death after hematopoietic stem cell transplantation: a cohort study on behalf of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation (EBMT).
abstract: BACKGROUND
  Relapse and transplant-related complications are leading causes of mortality after hematopoietic stem cell transplantation (HSCT). Suicides and accidents have not been studied in these patients. This study sought to determine whether there is an excess of suicide and accidental deaths after HSCT, and to determine risk factors.
  
  
  METHODS
  The incidence of suicidal and accidental death in patients after undergoing HSCT, standardized mortality ratio (SMR), and absolute excess risk (AER) of suicide and accidental deaths was determined, compared with the general European population. A case-control analysis was done to define factors associated with suicide and accidental deaths. Data were derived from the European Group for Blood and Marrow Transplantation Registry, including 294,922 patients who underwent autologous or allogeneic HSCT from 1980 to 2009.
  
  
  RESULTS
  The 10-year cumulative incidence of suicide and accidental deaths was 101.8 and 55.6 per 100,000 patients, respectively. SMR and AER of suicide after HSCT were 2.12 (P < .001) and 10.91, higher than in the European general population for 100,000 deaths, respectively. SMR and AER of accidental death were 1.23 (P < .05) and 2.54, respectively. In the case-control study, relapses were more frequent among patients who committed suicide after autologous HSCT (37% versus 18%; P < .0001). Chronic graft-versus-host disease was higher among patients who committed suicide after allogeneic HSCT (64% versus 37%; P = .001).
  
  
  CONCLUSIONS
  There is an excess of deaths due to suicide and accidents in patients after undergoing HSCT as compared with the European general population. Relapse was associated with more suicide and accidental deaths after autologous HSCT, and chronic graft-versus-host disease was associated with more deaths by suicide after allogeneic HSCT.
authors.affiliation: Division of Hematology, University Hospital Basel, Basel, Switzerland. tichelli@datacomm.ch
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Alicia
authors.initials: A
authors.lastname: Rovó
authors.forename: Manuela
authors.initials: M
authors.lastname: Badoglio
authors.forename: Mutlu
authors.initials: M
authors.lastname: Arat
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: van Lint
authors.forename: Anita
authors.initials: A
authors.lastname: Lawitschka
authors.forename: Carl Philipp
authors.initials: CP
authors.lastname: Schwarze
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
mesh_terms: D000059:Accidents / Q000523:psychology / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult