Conditional Survival, Cause-Specific Mortality, and Risk Factors of Late Mortality After Allogeneic Hematopoietic Cell Transplantation
Conditional Survival, Cause-Specific Mortality, and Risk Factors of Late Mortality After Allogeneic Hematopoietic Cell Transplantation
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DOI：
10.1093/jnci/djaa022
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发表时间：
2020-11-01
影响因子：
10.3
通讯作者：
Armenian, Saro H.
中科院分区：
文献类型：
--
作者：
Wong, F. Lennie;Teh, Jennifer Berano;Armenian, Saro H.
背景：造血细胞移植(HCT)后的长期死亡率传统上是从HCT开始计算的，忽略了幸存者死亡风险的时间变化。条件存活率，占已经存活的时间，与最佳生存护理的提供有关，但还没有被广泛量化。我们通过异基因血细胞移植患者的生存时间来评估条件存活率，并检查了特定原因的死亡率。方法：我们计算了1976-2014年间在一家大型移植中心接受HCT治疗的4485名恶性血液病患者的条件存活率和标准化死亡率。统计检验是两面性的。结果：本组5年生存率为48.6%。术后1、2、5、10、15年生存率分别为71.2%、78.7%、87.4%、93.5%和86.2%。标化死亡率为30.3(95%可信区间为29.2~35.5)。虽然在存活时间较长的患者中，标化死亡率有所下降，但在存活15年或更长时间的患者中，标化死亡率仍高出3.6倍(95%CI=3.0至4.1)。原发病占整个队列死亡的50%，在15年幸存者中只占10%；非疾病相关死亡的主要原因是随后的恶性肿瘤(26.1%)和心肺疾病(20.2%)。我们还确定了1年和5年幸存者中非疾病相关死亡率的危险因素。结论：HCT后患者生存时间越长，生存概率越高。然而，存活15年或更长时间的HCT接受者仍然面临较高的死亡风险，这主要是因为他们的原发病以外的健康状况。我们的研究结果有助于为预防和干预策略提供信息，以改善异基因HCT后的长期结果。
Background: Long-term mortality after hematopoietic cell transplantation (HCT) is conventionally calculated from the time of HCT, ignoring temporal changes in survivors' mortality risks. Conditional survival rates, accounting for time already survived, are relevant for optimal delivery of survivorship care but have not been widely quantified. We estimated conditional survival by elapsed survival time in allogeneic HCT patients and examined cause-specific mortality. Methods: We calculated conditional survival rates and standardized mortality ratio for overall and cause-specific mortality in 4485 patients who underwent HCT for malignant hematologic diseases at a large transplant center during 1976-2014. Statistical tests were two-sided. Results: The 5-year survival rate from HCT was 48.6%. After surviving 1, 2, 5, 10, and 15 years, the subsequent 5-year survival rates were 71.2%, 78.7%, 87.4%, 93.5%, and 86.2%, respectively. The standardized mortality ratio was 30.3 (95% confidence interval [CI] = 29.2 to 35.5). Although the standardized mortality ratio declined in longer surviving patients, it was still elevated by 3.6-fold in survivors of 15 years or more (95% CI = 3.0 to 4.1). Primary disease accounted for 50% of deaths in the overall cohort and only 10% in 15-year survivors; the leading causes of nondisease-related mortality were subsequent malignancy (26.1%) and cardiopulmonary diseases (20.2%). We also identified the risk factors for nondisease-related mortality in 1- and 5-year survivors. Conclusion: Survival probability improves the longer patients survive after HCT. However, HCT recipients surviving 15 years or more remain at elevated mortality risk, largely because of health conditions other than their primary disease. Our study findings help inform preventive and interventional strategies to improve long-term outcomes after allogeneic HCT.