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Blood, 1 June 2005, Vol. 105, No. 11, pp. 4215-4222.
Prepublished online as a Blood First Edition Paper on February 8, 2005; DOI 10.1182/blood-2005-01-0035.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study
Smita Bhatia,
Leslie L. Robison,
Liton Francisco,
Andrea Carter,
Yan Liu,
Marcia Grant,
K. Scott Baker,
Henry Fung,
James G. Gurney,
Philip B. McGlave,
Auayporn Nademanee,
Norma K. C. Ramsay,
Anthony Stein,
Daniel J. Weisdorf, and
Stephen J. Forman
From the City of Hope Cancer Center, Duarte, CA; University of Minnesota, Minneapolis; Fred Hutchinson Cancer Research Center, Seattle, WA; and University of California at Irvine, CA.
We assessed late mortality in 854 individuals who had survived 2 or more years after autologous hematopoietic cell transplantation (HCT) for hematologic malignancies. Median age at HCT was 36.5 years, and median length of follow-up was 7.6 years. Overall survival was 68.8% ± 1.8% at 10 years, and the cohort was at a 13-fold increased risk for late death (standardized mortality ratio [SMR] = 13.0) when compared with the general population. Mortality rates approached those of the general population after 10 years among patients at standard risk for relapse at HCT (SMR = 1.1) and in patients undergoing transplantation for acute myeloid leukemia (AML; SMR = 0.9). Relapse of primary disease (56%) and subsequent malignancies (25%) were leading causes of late death. Relapse-related mortality was increased among patients with Hodgkin disease (HD; relative risk [RR] = 3.6), non-Hodgkin lymphoma (NHL; RR = 2.1), and acute lymphoblastic leukemia (ALL; RR = 6.5). Total body irradiation (RR = 0.6) provided a protective effect. Nonrelapse-related mortality was increased after carmustine (RR = 2.3) and with use of peripheral blood stem cells (RR = 2.4). Survivors were more likely to report difficulty in holding jobs (RR = 9.4) and in obtaining health (RR = 7.7) or life insurance (RR = 8.4) when compared with siblings. Although mortality rates approach that of the general population after 10 years in certain subgroups, long-term survivors of autologous HCT continue to face challenges affecting their health and well-being.
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