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Blood, 15 November 2007, Vol. 110, No. 10, pp. 3784-3792.
Prepublished online as a Blood First Edition Paper on August 1, 2007; DOI 10.1182/blood-2007-03-082933.
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TRANSPLANTATION
Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study
Smita Bhatia1,
Liton Francisco1,
Andrea Carter1,
Can-Lan Sun1,
K. Scott Baker2,
James G. Gurney3,
Philip B. McGlave2,
Auayporn Nademanee4,
Margaret O'Donnell4,
Norma K. C. Ramsay2,
Leslie L. Robison5,
David Snyder4,
Anthony Stein4,
Stephen J. Forman4, and
Daniel J. Weisdorf2
1 Population Sciences, City of Hope National Medical Center, Duarte, CA;
2 Blood and Marrow Transplantation, University of Minnesota, Minneapolis;
3 Pediatrics, University of Michigan, Ann Arbor;
4 Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA; and
5 Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
We assessed late mortality in 1479 individuals who had survived 2 or more years after allogeneic hematopoietic cell transplantation (HCT). Median age at HCT was 25.9 years and median length of follow-up was 9.5 years. The conditional survival probability at 15 years from HCT was 80.2% (SE = 1.9%) for those who were disease-free at entry into the cohort, and the relative mortality was 9.9 (95% confidence interval, 8.7-11.2). Relative mortality decreased with time from HCT, but remained significantly elevated at 15 years after HCT (standardized mortality ratio = 2.2). Relapse of primary disease (29%) and chronic graft-versus-host disease (cGVHD: 22%) were the leading causes of premature death. Nonrelapse-related mortality was increased among patients older than 18 years at HCT (18-45 years: relative risk [RR] = 1.7; 46+ years: RR = 3.7) and among those with cGVHD (RR = 2.7), and was lower among patients who received methotrexate for GVHD prophylaxis (RR = 0.5). HCT survivors were more likely to report difficulty in holding jobs (odds ratio [OR] = 13.9), and in obtaining health (OR = 7.1) or life (OR = 9.9) insurance compared with siblings. This study demonstrates that mortality rates remain twice as high as that of the general population among 15-year survivors of HCT, and that the survivors face challenges affecting their health and well-being.
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