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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.
 Previous Article | Next Article 
Submitted March 29, 2007
Accepted July 27, 2007
Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the BMT survivor study
Smita Bhatia*, Liton Francisco, Andrea Carter, Can-Lan Sun, K Scott Baker, James G Gurney, Philip B McGlave, Auayporn Nademanee, Margaret O'Donnell, Norma KC Ramsay, Leslie L Robison, David Snyder, Anthony Stein, Stephen J Forman, and Daniel J Weisdorf
Division of Population Sciences, City of Hope National Medical Center, Duarte, CA, United States
Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, United States
Pediatrics, University of Michigan, Ann Arbor, MI, United States
Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States
Cancer Epidemiology and Control, St. Jude Children's Research Hospital, Memphis, TN, United States
* Corresponding author; email: sbhatia{at}coh.org.
We assessed late mortality in 1,479 individuals who had survived two 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 post-HCT (SMR=2.2). Relapse of primary disease (29%) and chronic graft versus host disease (cGVHD: 22%) were the leading causes of premature death. Non-relapse mortality was increased among patients older than 18 years at HCT (18-45: relative risk [RR]=1.7; 46+: RR=3.7); and among those with cGVHD (RR=2.7). Non-relapse mortality 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 insurance (OR=9.9) when compared with siblings. This study demonstrates that the mortality rate remains 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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