title: A national study on conditional survival, excess mortality and second cancer after high dose therapy with autologous stem cell transplantation for non-Hodgkin lymphoma.
abstract: This national population-based study aimed to investigate conditional survival and standardized mortality ratios (SMR) after high-dose therapy with autologous stem-cell transplantation (HDT-ASCT) for non-Hodgkin lymphoma (NHL), and to analyse cause of death, relapses and second malignancies. All patients ≥18 years treated with HDT-ASCT for NHL in Norway between 1987 and 2008 were included (n = 578). Information from the Cause of Death Registry and Cancer Registry of Norway were linked with clinical data. The 5-, 10- and 20-year overall survival was 61% (95% confidence interval [CI] 56-64%), 52% (95%CI 48-56%) and 45% (95%CI 40-50%), respectively. The 5-year survival conditional on having survived 2, 5 and 10 years after HDT-ASCT was 81%, 86% and 93%. SMRs were 12·3 (95%CI 11·0-13·9), 4·9 (95%CI 4·1-5·9), 2·4 (95%CI 1·8-3·2) and 1·0 (95%CI 0·6-1·8) for the entire cohort and for patients having survived 2, 5 and 10 years after HDT-ASCT respectively. Of the 281 deaths observed, 77% were relapse-related. Treatment-related mortality was 3·6%. The 10-year cumulative incidence of second malignancies was 7·9% and standardized incidence ratio was 2·0 (95%CI 1·5-2·6). NHL patients treated with HDT-ASCT were at increased risk of second cancer and premature death. The mortality was still elevated at 5 years, but after 10 years mortality equalled that of the general population.
authors.affiliation: National Advisory Unit on Late Effects, Department of Oncology, Oslo University Hospital, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Knut B
authors.initials: KB
authors.lastname: Smeland
authors.affiliation: National Advisory Unit on Late Effects, Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Cecilie E
authors.initials: CE
authors.lastname: Kiserud
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Grete F
authors.initials: GF
authors.lastname: Lauritzsen
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Blystad
authors.affiliation: Department of Oncology, St. Olavs Hospital, Trondheim, Norway.|Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Unn-Merete
authors.initials: UM
authors.lastname: Fagerli
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: Ragnhild S
authors.initials: RS
authors.lastname: Falk
authors.affiliation: Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.
authors.forename: Øystein
authors.initials: Ø
authors.lastname: Fluge
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fosså
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Kolstad
authors.affiliation: National Advisory Unit on Late Effects, Department of Oncology, Oslo University Hospital, Oslo, Norway.|Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Loge
authors.affiliation: Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Martin
authors.initials: M
authors.lastname: Maisenhölder
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Østenstad
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway.|Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital Oslo, Oslo, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Kvaløy
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D009664:Norway / Q000453:epidemiology; D012008:Recurrence; D012042:Registries; D016019:Survival Analysis; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: NHL; SMR; autologous stem cell transplantation; conditional survival; lymphoma