Life expectancy long, but not normal in patients who survived five years after hematopoietic cell transplantation

Patients who survived without recurrence longer than five years after hematopoietic cell transplantation had a high probability of surviving up to an additional 15 years. However, life expectancy never returns to that of the general population.

Researchers examined the cumulative effects of late complications on life expectancy in 2,574 patients who survived after allogeneic or autologous hematopoietic cell transplantation without recurrence of the original disease between 1970 and 2002.

The median follow-up was 13.1 years. Overall, there were 357 deaths. At 20 years after transplantation, estimated survival was 80.4% (95% CI, 78.1%-82.6%). There was a 30% decrease in life expectancy at any age. For patients of any age, mortality rates were fourfold to ninefold higher than the expected population rate 30 years or more after transplantation, according to researchers.

Factors associated with higher mortality rates and that had a greater effect on life expectancy included autologous transplantation, prior chronic graft-versus-host disease and transplantation before 1984.

The leading causes of mortality, in rank order, were second malignancies and recurrent disease, infections, chronic graft-versus-host disease, respiratory disease and cardiovascular diseases.

“Increased mortality rates emphasize the importance of ready access to high-quality health care and avoidance of exposures that might exacerbate the risks for second malignancies, infections and respiratory disease,” the researchers wrote. “Even though life expectancy does not return to normal, healthy survivors have a high probability of surviving for many additional years.”

Martin PJ. J Clin Oncol. 2010;doi:10.1200/JCO.2009.25.6693.