Mortality Remains Elevated Years after Allogeneic Hematopoietic Cell Transplantation

The following news from my e-mail file came from The Leukemia & Lymphoma Society news center. While, at first, alarming, the "hidden" positive in this release is that 2-year survival following a transplant can be expected to portend 80% survival for 15 years. And while survival rates following a transplant are far less than the general, healthy population, this research begs the question: What is the survival expectation without the treatment?

NEW YORK (Reuters Health) - Fifteen years after allogeneic hematopoietic cell transplantation (HCT), mortality rates among survivors are significantly higher than in the general population, according to a report in the November 15th issue Blood.

"Patients who survive 2 or more years disease-free after allogeneic HCT have an 80% probability of surviving for 15 years," Dr. Smita Bhatia from City of Hope National Medical Center in Duarte, California, told Reuters Health. "However, long-term (up to 15 years from HCT), the probability of dying prematurely is twice that of the general population. Survivors face a variety of obstacles, such as difficulty in holding jobs and in obtaining or retaining health and life insurance."

Dr. Bhatia and colleagues assessed late mortality and functional status in 1479 individuals who had survived 2 or more years after allogeneic HCT.

For the entire group, the probability of surviving was 86.6% at 5 years, 80.4% at 10 years, and 76.3% at 15 years from HCT, the authors report. Probabilities were somewhat higher for patients who did not suffer a relapse by 2 years after HCT.

Relative mortality was 78 times higher for years 2 to 5 than in the general population, 8 times higher for years 6 to 10, and 2-fold higher in patients followed for more than 15 years after HCT.

After relapse of primary disease, the leading causes of late mortality were chronic graft-versus-host disease, late infection in the absence of cGVHD, and treatment-related causes, the researchers note.



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