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Life expectancy remains shorter than expected after hematopoietic cell transplantation

Wingard JR. J Clin Oncol. 2011;doi:10.1200/JCO.2010.33.7212.

Issue: June 10, 2011

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Two years after allogeneic hematopoietic cell transplantation, estimated 5-year OS is only 89%. Death is rare after 2 years, so researchers said performing transplantation earlier and controlling graft-versus-host disease will result in improved survival.

Researchers reviewed the records collected by the Center for International Blood and Marrow Transplant Research of 10,632 patients worldwide who were alive and disease-free 2 years after receiving a myeloablative allogeneic hematopoietic cell transplantation (HCT) before 2004. Patients in study had all been treated with transplantation for acute myelogenous or lymphoblastic leukemia, myelodysplastic syndrome, lymphoma or severe aplastic anemia.

The median follow-up was 9 years, and 3,788 patients were observed for at least 10 years. The probability of survival at 10 years was 85%.

For patients who underwent transplantation for malignancy, cumulative incidences of relapse at 10 years after HCT were 10% for AML, 9% for ALL, 10% for myelodysplastic syndrome and 6% for lymphoma. For patients who underwent transplantation for malignancy, cumulative incidences of non-relapse mortality 10 years after HCT were 9% for AML, 9% for ALL, 12% for myelodysplastic syndrome and 11% for lymphoma.

Probabilities of DFS at 10 years were 82% for AML, 82% for ALL, 78% for myelodysplastic syndrome and 82% for lymphoma.

Older age and development of chronic graft-versus-host disease before 2 years were associated with late deaths in all diseases. Recurrent disease was the most common cause of death for patients who underwent transplantation for malignancy, followed by chronic graft-versus-host disease, infection, organ toxicity and second cancers. The most common causes of death for patients who underwent transplantation for severe aplastic anemia were graft-versus-host disease, infection, organ toxicity and second cancers.

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