Late Mortality and Causes of Death among Long-Term Survivors after Allogeneic Stem Cell Transplantation

Yoshiko Atsuta, Akihiro Hirakawa, Hideki Nakasone, Saiko Kurosawa, Kumi Oshima, Rika Sakai, Kazuteru Ohashi, Satoshi Takahashi, Takehiko Mori, Yukiyasu Ozawa, Takahiro Fukuda, Heiwa Kanamori, Yasuo Morishima, Koji Kato, Hiromasa Yabe, Hisashi Sakamaki, Shuichi Taniguchi, Takuya Yamashita

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19 Citations (Scopus)

Abstract

We sought to assess the late mortality risks and causes of death among long-term survivors of allogeneic hematopoietic stem cell transplantation (HCT). The cases of 11,047 relapse-free survivors of a first HCT at least 2 years after HCT were analyzed. Standardized mortality ratios (SMR) were calculated and specific causes of death were compared with those of the Japanese population. Among relapse-free survivors at 2 years, overall survival percentages at 10 and 15 years were 87% and 83%, respectively. The overall risk of mortality was significantly higher compared with that of the general population. The risk of mortality was significantly higher from infection (SMR = 57.0), new hematologic malignancies (SMR = 2.2), other new malignancies (SMR = 3.0), respiratory causes (SMR = 109.3), gastrointestinal causes (SMR = 3.8), liver dysfunction (SMR = 6.1), genitourinary dysfunction (SMR = 17.6), and external or accidental causes (SMR = 2.3). The overall annual mortality rate showed a steep decrease from 2 to 5 years after HCT; however, the decrease rate slowed after 10 years but was still higher than that of the general population at 20 years after HCT. SMRs in the earlier period of 2 to 4 years after HCT and 5 years or longer after HCT were 16.1 and 7.4, respectively. Long-term survivors after allogeneic HCT are at higher risk of mortality from various causes other than the underlying disease that led to HCT. Screening and preventive measures should be given a central role in reducing the morbidity and mortality of HCT recipients on long-term follow-up.

Original languageEnglish
JournalBiology of Blood and Marrow Transplantation
DOIs
Publication statusAccepted/In press - 2016 Feb 18

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Keywords

  • Causes of death
  • Late effects
  • Late mortality

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Atsuta, Y., Hirakawa, A., Nakasone, H., Kurosawa, S., Oshima, K., Sakai, R., Ohashi, K., Takahashi, S., Mori, T., Ozawa, Y., Fukuda, T., Kanamori, H., Morishima, Y., Kato, K., Yabe, H., Sakamaki, H., Taniguchi, S., & Yamashita, T. (Accepted/In press). Late Mortality and Causes of Death among Long-Term Survivors after Allogeneic Stem Cell Transplantation. Biology of Blood and Marrow Transplantation. https://doi.org/10.1016/j.bbmt.2016.05.019