title: A population-based cohort study of late mortality in adult autologous hematopoietic stem cell transplant recipients in Australia.
abstract: We assessed overall and cause-specific mortality and risk factors for late mortality in a nation-wide population-based cohort of 4547 adult cancer patients who survived 2 or more years after receiving an autologous hematopoietic stem cell transplantation (HSCT) in Australia between 1992 and 2005. Deaths after HSCT were identified from the Australasian Bone Marrow Transplant Recipient Registry and through data linkage with the National Death Index. Overall, the survival probability was 56% at 10 years from HSCT, ranging from 34% for patients with multiple myeloma to 90% for patients with testicular cancer. Mortality rates moved closer to rates observed in the age- and sex-matched Australian general population over time but remained significantly increased 11 or more years from HSCT (standardized mortality ratio, 5.9). Although the proportion of deaths from nonrelapse causes increased over time, relapse remained the most frequent cause of death for all diagnoses, 10 or more years after autologous HSCT. Our findings show that prevention of disease recurrence remains 1 of the greatest challenges for autologous HSCT recipients, while the increasing rates of nonrelapse deaths due to the emergence of second cancers, circulatory diseases, and respiratory diseases highlight the long-term health issues faced by adult survivors of autologous HSCT.
authors.affiliation: Molecular Epidemiology Group, Children's Cancer Institute Australia, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia. Electronic address: l.ashton@unsw.edu.au.
authors.forename: Lesley J
authors.initials: LJ
authors.lastname: Ashton
authors.affiliation: Molecular Epidemiology Group, Children's Cancer Institute Australia, School of Women and Children's Health, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Renate E
authors.initials: RE
authors.lastname: Le Marsney
authors.affiliation: The Australasian Bone Marrow Transplant Recipient Registry, St Vincent's Hospital, Darlinghurst, NSW, Australia; Department of Haematology and Stem Cell Transplantation, St Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dodds
authors.affiliation: The Australasian Bone Marrow Transplant Recipient Registry, St Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Nivison-Smith
authors.affiliation: The Australasian Bone Marrow Transplant Recipient Registry, St Vincent's Hospital, Darlinghurst, NSW, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Wilcox
authors.affiliation: Transplant Program, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.
authors.forename: Tracey A
authors.initials: TA
authors.lastname: O'Brien
authors.affiliation: Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Vajdic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: Cause of death; Hematopoietic stem cell transplantation; Survival