Long-Term Survival and Late Deaths After Allogeneic Hematopoietic Cell Transplantation

被引:500
作者
Wingard, John R.
Majhail, Navneet S.
Brazauskas, Ruta
Wang, Zhiwei
Sobocinski, Kathleen A.
Jacobsohn, David
Sorror, Mohamed L.
Horowitz, Mary M.
Bolwell, Brian
Rizzo, J. Douglas
Socie, Gerard
机构
[1] Univ Florida, Shands Hosp, Gainesville, FL 32610 USA
[2] Univ Minnesota, Med Ctr, Minneapolis, MN 55455 USA
[3] Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
[4] Childrens Natl Med Ctr, Washington, DC 20010 USA
[5] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[6] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[7] Hop St Louis, Paris, France
关键词
BONE-MARROW-TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; 5-YEAR SURVIVORS; LATE MORTALITY; SOLID CANCERS; LYMPHOPROLIFERATIVE DISORDERS; FUNCTIONAL STATUS; 2-YEAR SURVIVORS; CHILDHOOD-CANCER; RISK-FACTORS;
D O I
10.1200/JCO.2010.33.7212
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Allogeneic hematopoietic cell transplantation (HCT) is curative but is associated with life-threatening complications. Most deaths occur within the first 2 years after transplantation. In this report, we examine long-term survival in 2-year survivors in the largest cohort ever studied. Patients and Methods Records of 10,632 patients worldwide reported to the Center for International Blood and Marrow Transplant Research who were alive and disease free 2 years after receiving a myeloablative allogeneic HCT before 2004 for acute myelogenous or lymphoblastic leukemia, myelodysplastic syndrome, lymphoma, or severe aplastic anemia were reviewed. Results Median follow-up was 9 years, and 3,788 patients had been observed for 10 or more years. The probability of being alive 10 years after HCT was 85%. The chief risk factors for late death included older age and chronic graft-versus-host disease (GVHD). For patients who underwent transplantation for malignancy, relapse was the most common cause of death. The greatest risk factor for late relapse was advanced disease at transplantation. Principal risk factors for nonrelapse deaths were older age and GVHD. When compared with age, sex, and nationality-matched general population, late deaths remained higher than expected for each disease, with the possible exception of lymphoma, although the relative risk generally receded over time. Conclusion The prospect for long-term survival is excellent for 2-year survivors of allogeneic HCT. However, life expectancy remains lower than expected. Performance of HCT earlier in the course of disease, control of GVHD, enhancement of immune reconstitution, less toxic regimens, and prevention and early treatment of late complications are needed. J Clin Oncol 29: 2230-2239. (C) 2011 by American Society of Clinical Oncology
引用
收藏
页码:2230 / 2239
页数:10
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