Conditional Survival, Cause-Specific Mortality, and Risk Factors of Late Mortality After Allogeneic Hematopoietic Cell Transplantation
| Autor: | F. Lennie Wong, Stephen J. Forman, Dayana Chanson, Heeyoung Kim, Jennifer Berano Teh, Tracey Stiller, Ryotaro Nakamura, Liezl Atencio, Saro H. Armenian |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Adolescent medicine.medical_treatment Kaplan-Meier Estimate Hematopoietic stem cell transplantation California Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Survivorship curve medicine Humans Transplantation Homologous Young adult Child Survival rate Aged Cardiopulmonary disease 030219 obstetrics & reproductive medicine business.industry Hematopoietic Stem Cell Transplantation Infant Articles Middle Aged Hematologic Diseases Transplantation Standardized mortality ratio Oncology Child Preschool 030220 oncology & carcinogenesis Cohort Female business |
| Zdroj: | J Natl Cancer Inst |
| ISSN: | 1460-2105 0027-8874 |
| DOI: | 10.1093/jnci/djaa022 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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