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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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Submitted January 6, 2005
Accepted February 2, 2005
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 S Baker, Henry Fung, James G Gurney, Philip B McGlave, Auayporn Nademanee, Norma K Ramsay, Anthony Stein, Daniel J Weisdorf, and Stephen J Forman
City of Hope Cancer Center, Duarte, CA, USA
University of Minnesota, Minneapolis, MN, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, USA
University of California at Irvine, Irvine, CA, USA
* Corresponding author; email: sbhatia{at}coh.org.
We assessed late mortality in 854 individuals who had survived two or more years after autologous 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 of 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 of relapse at HCT (SMR=1.1), and in patients transplanted 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. Non-relapse-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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