TY - JOUR
T1 - Trends in Late Mortality and Life Expectancy After Autologous Blood or Marrow Transplantation Over Three Decades
T2 - A BMTSS Report
AU - Bhatia, Smita
AU - Dai, Chen
AU - Landier, Wendy
AU - Hageman, Lindsey
AU - Wu, Jessica
AU - Schlichting, Elizabeth
AU - Siler, Arianna
AU - Funk, Erin
AU - Hicks, Jessica
AU - Lim, Shawn
AU - Balas, Nora
AU - Bosworth, Alysia
AU - Te, Hok Sreng
AU - Francisco, Liton
AU - Bhatia, Ravi
AU - Salzman, Donna
AU - Goldman, Frederick D.
AU - Forman, Stephen J.
AU - Weisdorf, Daniel J.
AU - Wong, F. Lennie
AU - Armenian, Saro H.
AU - Arora, Mukta
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2022/6/20
Y1 - 2022/6/20
N2 - PURPOSE: We determined trends in life expectancy and cause-specific late mortality after autologous blood or marrow transplantation (BMT) performed over a 30-year period, using the BMT Survivor Study.METHODS: We constructed a cohort of 4,702 individuals with hematologic neoplasms who lived ≥ 2 years after autologous BMT performed between 1981 and 2014 at three transplant centers. The end of follow-up was April 19, 2021. The primary exposure variable was autologous BMT performed in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurinct databases.RESULTS: The median age at BMT was 53 years (range, 0-78 years), 58.7% were male, 67.8% were non-Hispanic White, and 28.3% had undergone transplantation between 2011 and 2014. Autologous BMT recipients experienced a 7-year reduction in life expectancy. The adjusted hazard of 5-year all-cause mortality declined over the four eras (reference: 1981-1999; hazard ratio [HR]
2000-2005 = 0.77; 95% CI, 0.62 to 0.94; HR
2006-2010 = 0.64; 95% CI, 0.51 to 0.79; HR
2011-2014 = 0.56; 95% CI, 0.45 to 0.71;
P
trend < .001), as did years of life lost (5.0 years to 1.6 years). The reduction in all-cause mortality was most pronounced among those transplanted for Hodgkin lymphoma or plasma cell dyscrasias, but was not observed among those transplanted for non-Hodgkin lymphoma or those conditioned with total-body irradiation. We also observed a decline in late deaths because of infection (
P
trend < .0001; primarily for BMTs before 2006) and subsequent neoplasms (
P
trend = .03; confined to decline in therapy-related myeloid neoplasm-related mortality) but not because of cardiovascular or renal disease.
CONCLUSION: Late mortality among autologous BMT recipients has declined over a 30-year period. However, ongoing efforts are needed to mitigate development of infections, subsequent neoplasms, and cardiovascular and renal disease to further reduce late mortality.
AB - PURPOSE: We determined trends in life expectancy and cause-specific late mortality after autologous blood or marrow transplantation (BMT) performed over a 30-year period, using the BMT Survivor Study.METHODS: We constructed a cohort of 4,702 individuals with hematologic neoplasms who lived ≥ 2 years after autologous BMT performed between 1981 and 2014 at three transplant centers. The end of follow-up was April 19, 2021. The primary exposure variable was autologous BMT performed in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurinct databases.RESULTS: The median age at BMT was 53 years (range, 0-78 years), 58.7% were male, 67.8% were non-Hispanic White, and 28.3% had undergone transplantation between 2011 and 2014. Autologous BMT recipients experienced a 7-year reduction in life expectancy. The adjusted hazard of 5-year all-cause mortality declined over the four eras (reference: 1981-1999; hazard ratio [HR]
2000-2005 = 0.77; 95% CI, 0.62 to 0.94; HR
2006-2010 = 0.64; 95% CI, 0.51 to 0.79; HR
2011-2014 = 0.56; 95% CI, 0.45 to 0.71;
P
trend < .001), as did years of life lost (5.0 years to 1.6 years). The reduction in all-cause mortality was most pronounced among those transplanted for Hodgkin lymphoma or plasma cell dyscrasias, but was not observed among those transplanted for non-Hodgkin lymphoma or those conditioned with total-body irradiation. We also observed a decline in late deaths because of infection (
P
trend < .0001; primarily for BMTs before 2006) and subsequent neoplasms (
P
trend = .03; confined to decline in therapy-related myeloid neoplasm-related mortality) but not because of cardiovascular or renal disease.
CONCLUSION: Late mortality among autologous BMT recipients has declined over a 30-year period. However, ongoing efforts are needed to mitigate development of infections, subsequent neoplasms, and cardiovascular and renal disease to further reduce late mortality.
KW - Bone Marrow
KW - Bone Marrow Transplantation/adverse effects
KW - Female
KW - Humans
KW - Life Expectancy
KW - Male
KW - Neoplasms
KW - Transplantation, Autologous
KW - Transplantation, Homologous
UR - http://www.scopus.com/inward/record.url?scp=85131299219&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131299219&partnerID=8YFLogxK
U2 - 10.1200/JCO.21.02372
DO - 10.1200/JCO.21.02372
M3 - Article
C2 - 35263165
AN - SCOPUS:85131299219
SN - 0732-183X
VL - 40
SP - 1991
EP - 2003
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 18
ER -
