Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: Report from the Bone Marrow Transplant Survivor study

Authors

Smita Bhatia, City of Hope National Med CenterFollow
Liton Francisco, City of Hope National Med CenterFollow
Andrea Carter, City of Hope National Med CenterFollow
Can Lan Sun, City of Hope National Med Center
K. Scott Baker, University of Minnesota Twin Cities
James G. Gurney, University of Michigan, Ann Arbor
Philip B. McGlave, University of Minnesota Twin Cities
Auayporn Nademanee, City of Hope National Med Center
Margaret O'Donnell, City of Hope National Med Center
Norma K.C. Ramsay, University of Minnesota Twin Cities
Leslie L. Robison, St. Jude Children's Research Hospital
David Snyder, City of Hope National Med Center
Anthony Stein, City of Hope National Med Center
Stephen J. Forman, City of Hope National Med CenterFollow
Daniel J. Weisdorf, University of Minnesota Twin Cities

Abstract

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. © 2007 by The American Society of Hematology.

Publication Title

Blood

Recommended Citation

Bhatia, S., Francisco, L., Carter, A., Sun, C., Scott Baker, K., Gurney, J., McGlave, P., Nademanee, A., O'Donnell, M., Ramsay, N., Robison, L., Snyder, D., Stein, A., Forman, S., & Weisdorf, D. (2007). Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: Report from the Bone Marrow Transplant Survivor study. Blood, 110 (10), 3784-3792. https://doi.org/10.1182/blood-2007-03-082933