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. 2020 Jan;55(1):126-136.
doi: 10.1038/s41409-019-0624-z. Epub 2019 Aug 27.

Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors

Jan Styczyński  1 , Gloria Tridello  2 , Linda Koster  3 , Simona Iacobelli  4 , Anja van Biezen  3 , Steffie van der Werf  3 , Małgorzata Mikulska  5 , Lidia Gil  6 , Catherine Cordonnier  7 , Per Ljungman  8 , Diana Averbuch  9 , Simone Cesaro  2 , Rafael de la Camara  10 , Helen Baldomero  11 , Peter Bader  12 , Grzegorz Basak  13 , Chiara Bonini  14 , Rafael Duarte  15 , Carlo Dufour  16 , Jurgen Kuball  17 , Arjan Lankester  18 , Silvia Montoto  19 , Arnon Nagler  20 , John A Snowden  21 , Nicolaus Kröger  22 , Mohamad Mohty  23 , Alois Gratwohl  24 ; Infectious Diseases Working Party EBMT
Affiliations

Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors

Jan Styczyński et al. Bone Marrow Transplant. 2020 Jan.

Abstract

Information on incidence, and factors associated with mortality is a prerequisite to improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55'668 deaths in 114'491 patients with HSCT (83.7% allogeneic) for leukemia were investigated in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year (intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980-2001) to cohort 2 (2002-2015) in all post-transplant phases after autologous HSCT. After allogeneic HSCT, mortality from infections, GVHD, and toxicity decreased up to 1 year, increased at 5 years; deaths from relapse increased in all post-transplant phases. Infections of unknown origin were the main cause of infectious deaths. Lethal bacterial and fungal infections decreased from cohort 1 to cohort 2, not unknown or mixed infections. Infectious deaths were associated with patient-, disease-, donor type, stem cell source, center, and country- related factors. Their impact varied over the post-transplant phases. Transplant centres have successfully managed to reduce death after HSCT in the early and intermediate post-transplant phases, and have identified risk factors. Late post-transplant care could be improved by focus on groups at risk and better identification of infections of "unknown origin".

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidences of mortality after HSCT over four post-transplant phases and from cohort 1 to cohort 2. The stacked curves for the four post-transplant phases for the two cohorts combined in landmark analysis are presented: a 30-day mortality; b 100-day mortality (for patients alive at day 30); c 1-year mortality (for patients alive at day 100); d 5-year mortality (for patients alive at 1 year)
Fig. 2
Fig. 2
Main causes of death and of infectious deaths after HSCT. Main cause of death (in %)by post-transplant phase and by cohorts 1 and 2 (1 = cohort 1980–2001; 2 = cohort 2002–2015): a all patients; b allo-HSCT patients; c auto-HSCT patients. Cumulative incidences of mortality for the respective cause of death during the 4 post-transplant time periods, day 0 to day 30, day 30 to day 100, day 100 to 1 year, and 1 year to 5 years (see methods section for details), are shown
Fig. 3
Fig. 3
Main causes of death and of infectious deaths after HSCT. Causes of infectious deaths by post-transplant phase. Changes over time of causes of infectious deaths (in %) after HSCT for leukemia by post-transplant phase (1 = cohort 1980–2001; 2 = cohort 2002–2015): a all patients; b allo-HSCT patients; c auto-HSCT patients. Cumulative incidences of mortality for the respective cause of death during the 4 post-transplant time periods, day 0 to day 30, day 30 to day 100, day 100 to 1 year, and 1 year to 5 years (see methods section for details), are shown
See this image and copyright information in PMC

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