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Background: Allogeneic hematopoietic cell transplantation (alloHCT) is an established curative treatment for many hematologic diseases. The number of long-term survivors grows. Conditional survival rates, accounting for time already survived, are relevant for optimal delivery of survivorship care. Methods: We estimated conditional survival rates, and overall and cause-specific mortality risk in a retrospective cohort study of 4485 patients who underwent alloHCT for hematologic diseases during 1976-2014. Findings: The 5-year survival rate from HCT for the cohort was 48%. After surviving 1, 2, 5, 10, and 15 years, the subsequent 5-year survival rates were 71%, 79%, 87%, 94%, and 86%, respectively. The standardized mortality ratio (SMR) was 30·3 (95% confidence interval [CI], 29·2-35·5). Although the SMR declined in longer surviving patients, it was still elevated by 3·6-fold in ≥15-year survivors (95% CI, 3·0-4·1)· Primary disease accounted for 50% of deaths in the overall cohort, and only 10% in ≥15-year survivors; the leading causes of non-disease-related mortality were subsequent malignancy (26·1%) and cardiopulmonary diseases (20·2%)· The risk factors for non-disease-related mortality were male sex, older age at HCT, having an unrelated donor, graft-versus-host disease within one-year of HCT, total body irradiation conditioning, and undergoing HCT in an earlier transplantation era. Interpretation: Survival probability improves the longer patients survive. However, HCT recipients surviving ≥15 years remain at elevated mortality risk, largely due to health conditions other than their primary disease. Our study findings inform preventive and interventional strategies to improve long-term outcomes after HCT. Funding Statement: Lymphoma & Leukemia Society Scholar Award (Armenian). Declaration of Interests: None of the authors have any financial or personal conflict of interest. Ethics Approval Statement: The LTFU protocol was approved by the Institutional Review Board at COH; written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. |
