title: Mortality patterns among recipients of autologous hematopoietic stem cell transplantation for lymphoma and myeloma in the past three decades.
abstract: BACKGROUND
  Understanding the mortality patterns of patients with lymphoma and myeloma, who have undergone autologous hematopoietic stem cell transplantation (ASCT) might identify improvement opportunities.
  
  
  METHODS
  The present retrospective study included patients with lymphoma and myeloma, aged ≥ 18 years, who had undergone ASCT from 1983 to 2010 at the University of Nebraska Medical Center. Of the 2284 patients, 972 had died within first 5 years after ASCT. The patients were divided into 3 cohorts according to the time of transplantation: 1983 to 1990 (cohort I), 1991 to 2000 (cohort II), and 2001 to 2010 (cohort III). Using Cox proportional hazards regression analysis, the risk of cause-specific mortality was compared across the 3 cohorts.
  
  
  RESULTS
  Of a total of 1215 deaths, 972 (80%) occurred within the first 5 years after ASCT. Disease relapse (73.4%), organ failure (7.8%), infection (4.7%), and secondary malignancy (4.2%) accounted for most of the deaths. The risk of death from infection (P < .0001), but not from relapse (P = .26), organ failure (P = .68), or secondary malignancy (P = .15), had declined in the more recent cohorts.
  
  
  CONCLUSIONS
  The 5-year overall survival of patients undergoing ASCT has improved significantly owing to a decline in infectious mortality. Our results highlight that the mortality from relapse remains the most common cause of death, warranting investigation of different strategies to reduce the incidence of relapse and improve the therapy for relapse after ASCT.
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Vijaya Raj
authors: VR
authors: Bhatt
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Fausto R
authors: FR
authors: Loberiza
authors: Department of Hematology, Third Hospital, Peking University, Peking, China.
authors: Hongmei
authors: H
authors: Jing
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: R Gregory
authors: RG
authors: Bociek
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Philip J
authors: PJ
authors: Bierman
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Lori J
authors: LJ
authors: Maness
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: Julie M
authors: JM
authors: Vose
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
authors: James O
authors: JO
authors: Armitage
authors: Division of Hematology-Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: mojtaba.akhtari@unmc.edu.
authors: Mojtaba
authors: M
authors: Akhtari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006689:Hodgkin Disease / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000401:mortality; D014182:Transplantation, Autologous / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
keywords: Autologous stem cell transplantation; Causes of death; Hodgkin lymphoma; Multiple myeloma; Non-Hodgkin lymphoma