74 Late Mortality and Causes of Death Among Long-Term Survivors After Allogeneic Stem Cell Transplantation

Track: BMT Tandem "Scientific" Meeting
Saturday, February 16, 2013, 4:45 PM-6:45 PM
Ballroom I-J (Salt Palace Convention Center)
Yoshiko Atsuta, MD, PhD , Department of HSCT, Data Management / Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan
Hideki Nakasone, MD, PhD , Saitama Medical Center, Jichi Medical University, Saitama, Japan
Saiko Kurosawa, MD , Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
Kumi Oshima, MD, PhD , St. Luke's International Hospital, Tokyo, Japan
Rika Sakai, MD, PhD , Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
Kazuteru Ohashi, MD, PhD , Division of Hematology, Tokyo Metropolitan Cancer and Infectious diseases Center, Tokyo, Japan
Takahiro Fukuda, MD, PhD , Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
Satoshi Takahashi, MD, PhD , Department of Molecular Therapy, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
Takehiko Mori, MD, PhD , Division of Hematology, Keio University School of Medicine, Tokyo, Japan
Yasuo Morishima, MD, PhD , Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
Koji Kato, MD, PhD , Department of Pediatric Hematology and Oncology, Japanese Red Cross Nagoya First Hospital
Hiromasa Yabe, MD, PhD , Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
Hisashi Sakamaki, MD, PhD , Division of Hematology, Tokyo Metropolitan Cancer and Infectious diseases Center, Tokyo, Japan
Shuichi Taniguchi, MD, PhD , Department of Hematology, Toranomon Hospital, Tokyo, Japan
Objective: Increase in the number of hematopoietic stem cell transplantation (HCT) and its improvement has led to increase in the number of long-term survivors post HCT. We have assessed risks of late mortality and causes of death among long term survivors after allogeneic hematopoietic stem cell transplantation (HCT).

Patients and methods: 10,512 recipients of first allogeneic HCT for hematological diseases, who were relapse-free survivors of at least two years post transplant were subjects for analyses. Median age at transplant was 29 (range, 0-76). 58% received stem cells from related donors. 78% received bone marrow, 14% received peripheral blood stem cell, and 8% received cord blood. 77% received myeloablative conditioning. Median follow-up for survivors was 7 years (range, 2 to 28). A total of 57,766 person-years were observed. 6,884 recipients were followed for more than 5 years (32,438 person years for observation period of 5 years or longer). Standarized mortality ratio (observed / expected ratio) was calculated for comparison with general population in Japan for specific causes of death.

Results: Among relapse-free survivors at 2 years, overall survival at 10 years, 15years were 86%, and 82%. Probabilities were 95% and 91% when subjects were limited to relapse-free survivors at 5 years. When compared to general population in Japan, risk of overall mortality was significantly higher (observed / expected ratio [O/E] = 15.1, 95%CI, 14.3-16.0). The risk of mortality was significantly higher with infection (O/E=89.8, 95%CI, 77.4-100.7), new malignancy (O/E=3.2, 95%CI, 2.6-4.0), cardiovascular (O/E=2.3, 95%CI, 1.5-3.5), respiratory (O/E=150.9, 95%CI, 131.1-172.5) including chronic obstructive lung disease (O/E=182.2, 95%CI, 101.2-214.1), digestive (O/E=4.2, 95%CI, 1.4-9.7), liver (O/E=10.5, 95%CI, 7.4-14.8), kidney-genitourinary (O/E=23.6, 95%CI, 13.1-37.1), and external cause (O/E=2.5, 95%CI, 1.5-3.8) compared to general population. The risk of death from any cause was approximately twenty times higher from 2 to 4 years after transplant for relapse-free survivors at 2 years (O/E=21.1, 95%CI, 19.6-22.6) compared to general population. The risk was still ten times higher with statistical significance for the subjects after 5 years post transplant (O/E=10.0, 95%CI, 9.1-11.0).

Conclusions: Long-term survivors after allogeneic HCT are at higher risk of mortality due to various causes other than underlying diseases. Screening and preventive practices are important for long-term follow up of HCT recipients.

See more of: Oral Abstracts - Session J - Late Effects/Quality of Life & Immune Reconstitution
See more of: BMT Tandem "Scientific" Meeting
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