Late mortality after autologous blood or marrow transplantation in childhood: A Blood or Marrow Transplant Survivor Study-2 report

Anna Sällfors Holmqvist, Yanjun Chen, Jessica Wu, Kevin Battles, Ravi Bhatia, Liton Francisco, Lindsey Hageman, Michelle Kung, Emily Ness, Mariel Parman, Donna Salzman, Jeanette Falck Winther, Joseph Rosenthal, Stephen J. Forman, Daniel J Weisdorf, Mukta Arora, Saro H. Armenian, Smita Bhatia

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Autologous blood or marrow transplantation (BMT) is a curative option for several types of childhood cancer. However, there is little information regarding the risk of late mortality. We examined all-cause mortality, relapse-related mortality (RRM), and nonrelapse-related mortality (NRM) in 2-year survivors of autologous BMT performed before age 22 between 1980 and 2010 at 1 of 2 US transplant centers. Vital status information was collected using medical records, National Death Index, and Accurint databases. Overall survival was calculated using Kaplan-Meier techniques. Cumulative incidence of mortality used competing risk methods. Standardized mortality ratio (SMR) was calculated using age-, sex-, and calendar-specific mortality rates from Centers for Disease Control and Prevention. Cox regression analysis was used to determine predictors of all-cause late mortality. Among the 345 2-year survivors, 103 deaths were observed, yielding an overall survival of 70.3% 15 years post-BMT. The leading causes of death included primary disease (50.0%), subsequent neoplasm (21.4%), and infection (18.2%). Overall, the cohort was at a 22-fold increased risk of late mortality (SMR, 21.8; 95% CI, 17.9-26.3), compared with the general population. Mortality rates remained elevated among the 10-year survivors (SMR, 20.6; 95% CI, 9.9-37.2) but approached those of the general population ≥15 years post-BMT. The 10-year cumulative incidence of RRM (14.3%) exceeded that of NRM (10.4%). The 10-year cumulative mortality rate declined over time (<1990, 35.1%; 1990-1999, 25.6%; 2000-2010, 21.8%; P 5 .05). In conclusion, childhood autologous BMT recipients have an increased risk of late mortality, compared with the general population. The late mortality rates have declined over the past 3 decades.

Original languageEnglish (US)
Pages (from-to)2720-2729
Number of pages10
JournalBlood
Volume131
Issue number24
DOIs
StatePublished - Jun 14 2018

Bibliographical note

Funding Information:
This work was supported in parts by grants from the National Cancer Institute, National Institutes of Health (R01 CA078938), the Leukemia Lymphoma Society (R6502-16), and the Swedish Childhood Cancer Foundation (TJ2016-0014).

Publisher Copyright:
© 2018 by The American Society of Hematology.

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