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. 2020 Feb 25;3(1):11-17.
doi: 10.31547/bct-2019-011.

Late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation

Minako Iida  1 , Hideki Nakasone  2 , Takuya Yamashita  3 , Masami Inoue  4 , Yasushi Ishida  5 , Hitoji Uchiyama  6 , Yuta Katayama  7 , Toshihiro Miyamoto  8 , Satoshi Yoshioka  9 , Souichi Shiratori  10 , Takehiko Mori  11 , Masashi Sawa  12 , Yasuhiro Sugio  13 , Takahiro Fukuda  14 , Tatsuo Ichinohe  15 , Yoshiko Atsuta  16 , Yoshihiro Inamoto  14 ; Late Effect and Quality of Life Working Group of the Japan Society for Hematopoietic Cell Transplantation
Affiliations

Late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation

Minako Iida et al. Blood Cell Ther. .

Abstract

By evaluating risks of late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation (HSCT) in Japan, we clarified what we should focus on during follow-up to reduce them. The study cohort included 6,780 patients who had survived for ≥2 years after the first autologous HSCT performed from 1974 to 2012 for hematological diseases. With a median follow-up of 6.0 years among survivors, overall survival probabilities at 5 and 10 years after HSCT were 92% and 83%, respectively. Eight hundred thirty deaths occurred: 451, recurrent primary diseases; 87, subsequent solid cancers; 57, subsequent hematological malignancies; 55, infections; 41, respiratory diseases; 19, cardiovascular diseases; 15, liver diseases; 10, neurological diseases; and 7, kidney/genitourinary diseases (Except small numbers of other causes and missing). According to the log-rank test, the risk of overall mortality was remarkably increased among HSCT recipients compared with the that in the general Japanese population (observed/expected ratio [O/E]=5.4; 95% confidence interval [CI], 5.0-5.8). The risks of cause-specific mortality increased with infection (O/E=6.8; 95% CI, 5.1-8.8), subsequent solid cancers (O/E=1.4; 95% CI, 1.1-1.7), subsequent hematological malignancies (O/E=14.3; 95% CI, 10.8-18.5), kidney/genitourinary diseases (O/E=3.4; 95% CI, 1.4-7.1), respiratory disease (O/E=9.0; 95% CI, 6.5-1.2), and liver diseases (O/E=2.6; 95% CI, 1.4-4.2). Long-term survivors after autologous HSCT are at an increased risk of death due to secondary cancers, infections, and any organ diseases as well as recurrence compared to the general population. When monitoring these patients in the outpatient clinic, it is important for physicians to predict a change in the patient's condition and to start treatment earlier.

Keywords: Autologous HSCT; Cause of death; Late mortality; Long-term survivors.

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Conflict of interest statement

Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University, where Iida belongs, has received donations from Kyowa Kirin Co., Ltd., JCR Pharmaceuticals Co., Ltd., Clinigen K. K., Astellas Pharma Inc., Genzyme Japan K. K., CHUGAI PHARMACEUTICAL CO., LTD., Janssen Pharmaceutical K. K., and Sanofi K. K.. Other authors have no conflict of interest to declare. Disclosure forms provided by the authors are available here.

Figures

Figure 1.
Figure 1.. Probabilities of overall survival among recurrence-free survivors over time
The probability of overall survival among recurrence-free survivors at 2 years after autologous hematopoietic stem cell transplantation was 82.6% at 12 years.
Figure 2.
Figure 2.. Frequency of causes of death
Other causes of death include kidney and genitourinary diseases, external (accidental) injuries, endocrine/diabetes, digestive tract disorders, suicide, bleeding, sudden death, and multiorgan failure.
See this image and copyright information in PMC

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References

    1. Gratwohl A, Pasquini MC, Aljurf M, Atsuta Y, Baldomero H, Foeken L, et al. One million haemopoietic stem-cell transplants: a retrospective observational study. The Lancet Haematology. 2015; 2: e91-e100. - PubMed
    1. Atsuta Y, Suzuki R, Yoshimi A, Gondo H, Tanaka J, Hiraoka A, et al. Unification of hematopoietic stem cell transplantation registries in Japan and establishment of the TRUMP System. Int J Hematol. 2007; 86: 269-74. - PubMed
    1. Atsuta Y. Introduction of Transplant Registry Unified Management Program 2 (TRUMP2): scripts for TRUMP data analyses, part I (variables other than HLA-related data). Int J Hematol. 2016; 103: 3-10. - PubMed
    1. WHO. World Health Organization. List of Official ICD-10 Updates. 2014 WHO, 2014, World Health Organization. List of Official ICD-10 Updatesr. https://www.who.int/classifications/icd/icd10updates/en/ [Accessed September 28, 2019]
    1. Atsuta Y, Hirakawa A, Nakasone H, Kurosawa S, Oshima K, Sakai R, et al. Late Mortality and Causes of Death among Long-Term Survivors after Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2016; 22: 1702-9. - PubMed

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