title: Late mortality after hematopoietic SCT for a childhood malignancy.
abstract: Hematopoietic SCT (HSCT) has been used as a curative therapy for pediatric malignancies. Survivors of HSCT are at risk for disease recurrence, late morbidity and mortality. We assessed late mortality (≥2 years post-HSCT) in a population-based cohort of children who underwent HSCT for a malignancy. Mortality outcomes were determined by linking a clinical transplant database with the Canadian province of Ontario's pediatric cancer mortality files. Seven hundred and fifty-four children underwent HSCT (371 allogeneic, 383 autologous). Of the 479 (63.5%) who were alive ≥2 years post HSCT, 98 (20.5%) suffered a late death. Late mortality in the allogeneic HSCT group was 14.9% (median follow-up 10.0 years; range: 2.0-25.6 years), mainly due to relapse of the primary malignancy (64.7%). Chronic GVHD and second malignancies were not major causes of late mortality. A total of 25.5% suffered a late death following autologous HSCT (median follow-up 6.7 years; range: 2.0-22.2 years). Recurrence of the primary malignancy accounted for 87.5% of these deaths. Recurrence of the primary malignancy is the predominant cause of late mortality after HSCT. In contrast to studies of adult patients, non-relapse mortality is less common in children, and death due to chronic GVHD and secondary malignancies is uncommon.
authors.affiliation: Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Schechter
authors.forename: J D
authors.initials: JD
authors.lastname: Pole
authors.forename: D
authors.initials: D
authors.lastname: Darmawikarta
authors.forename: J
authors.initials: J
authors.lastname: Doyle
authors.forename: M
authors.initials: M
authors.lastname: Ali
authors.forename: M
authors.initials: M
authors.lastname: Egeler
authors.forename: A
authors.initials: A
authors.lastname: Gassas
authors.forename: M S
authors.initials: MS
authors.lastname: Irwin
authors.forename: M
authors.initials: M
authors.lastname: Greenberg
authors.forename: P C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009864:Ontario / Q000453:epidemiology; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome; D055815:Young Adult