Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study
Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study
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DOI：
10.1182/blood-2005-01-0035
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发表时间：
2005-06-01
期刊：
影响因子：
20.3
通讯作者：
Forman, SJ
中科院分区：
文献类型：
--
作者：
Bhatia, S;Robison, LL;Forman, SJ
我们评估了 854 名因血液恶性肿瘤进行自体造血细胞移植 (HCT) 后存活 2 年或以上的个体的晚期死亡率。 HCT 的中位年龄为 36.5 岁，中位随访时间为 7.6 年。 10 年总生存率为 68.8% +/- 1.8%，与一般人群相比，该队列的晚期死亡风险增加了 13 倍（标准化死亡率 [SMR] = 13.0）。 HCT 复发标准风险患者 (SMR = 1.1) 和接受急性髓系白血病移植的患者 (AML; SMR = 0.9) 10 年后死亡率接近普通人群。原发疾病复发（56%）和随后的恶性肿瘤（25%）是晚期死亡的主要原因。霍奇金病（HD；相对风险 [RR] = 3.6）、非霍奇金淋巴瘤（NHL；RR = 2.1）和急性淋巴细胞白血病（ALL；RR = 6.5）患者的复发相关死亡率增加。全身照射（RR = 0.6）提供了保护作用。卡莫司汀后（RR = 2.3）和使用外周血干细胞（RR = 2.4）后非复发相关死亡率增加。与兄弟姐妹相比，幸存者更有可能报告在保住工作（RR = 9.4）和获得健康（RR = 7.7）或人寿保险（RR = 8.4）方面存在困难。尽管某些亚组的死亡率在 10 年后接近普通人群，但自体 HCT 的长期幸存者仍然面临影响其健康和福祉的挑战。
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. Nonrelapse-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.