Late mortality in survivors of autologous hematopoietic-cell transplantation: Report from the Bone Marrow Transplant Survivor Study

Authors

Smita Bhatia, City of Hope National Med CenterFollow
Leslie L. Robison
Liton FranciscoFollow
Andrea CarterFollow
Yan Liu
Marcia Grant
K. Scott BakerFollow
Henry Fung
James G. Gurney
Philip B. McGlave
Auayporn Nademanee
Norma K.C. Ramsay
Anthony Stein
Daniel J. Weisdorf
Stephen J. FormanFollow

Abstract

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. 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. © 2005 by The American Society of Hematology.

Publication Title

Blood

Recommended Citation

Bhatia, S., Robison, L., Francisco, L., Carter, A., Liu, Y., Grant, M., Baker, K., Fung, H., Gurney, J., McGlave, P., Nademanee, A., Ramsay, N., Stein, A., Weisdorf, D., & Forman, S. (2005). Late mortality in survivors of autologous hematopoietic-cell transplantation: Report from the Bone Marrow Transplant Survivor Study. Blood, 105 (11), 4215-4222. https://doi.org/10.1182/blood-2005-01-0035