Conditional Survival, Cause-Specific Mortality, and Risk Factors of Late Mortality After Allogeneic Hematopoietic Cell Transplantation

Abstract

Background Long-term mortality after hematopoietic cell transplantation (HCT) is conventionally calculated from the time of HCT, ignoring temporal changes in survivors’ mortality risks. Conditional survival rates, accounting for time already survived, are relevant for optimal delivery of survivorship care but have not been widely quantified. We estimated conditional survival by elapsed survival time in allogeneic HCT patients and examined cause-specific mortality. Methods We calculated conditional survival rates and standardized mortality ratio for overall and cause-specific mortality in 4485 patients who underwent HCT for malignant hematologic diseases at a large transplant center during 1976–2014. Statistical tests were two-sided. Results The 5-year survival rate from HCT was 48.6%. After surviving 1, 2, 5, 10, and 15 years, the subsequent 5-year survival rates were 71.2%, 78.7%, 87.4%, 93.5%, and 86.2%, respectively. The standardized mortality ratio was 30.3 (95% confidence interval [CI] = 29.2 to 35.5). Although the standardized mortality ratio declined in longer surviving patients, it was still elevated by 3.6-fold in survivors of 15 years or more (95% CI = 3.0 to 4.1). Primary disease accounted for 50% of deaths in the overall cohort and only 10% in 15-year survivors; the leading causes of nondisease-related mortality were subsequent malignancy (26.1%) and cardiopulmonary diseases (20.2%). We also identified the risk factors for nondisease-related mortality in 1- and 5-year survivors. Conclusion Survival probability improves the longer patients survive after HCT. However, HCT recipients surviving 15 years or more remain at elevated mortality risk, largely because of health conditions other than their primary disease. Our study findings help inform preventive and interventional strategies to improve long-term outcomes after allogeneic HCT.

Conditional survival after surgery for patients with penile cancer

“…To date, the CS models have been reported in many types of malignancies from the genitourinary 10,[14][15][16][17][18] and other primary sites, 8,[19][20][21][22] but little was investigated in penile cancer. To our knowledge, only Thuret et al 23 and Mistretta et al 18 have successively employed the CS method to explain the prognosis of SCCP patients.…”

Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors

“…Medical records at COH were the primary source of data for this study, and data were abstracted using an established long-term follow-up protocol. 5,[16][17][18][19] In brief, if the date of last medical visit at COH was not recent (e.g., >12 months before 31 December 2017), or if there were any gaps in the patients' history within the window of interest, a standard protocol was used to identify and contact patients and/or physicians to request non-COH medical records. The protocol was approved by COH institutional review board, and informed consent was obtained according to the Declaration of Helsinki.…”

“…2,3 Specifically, HCT survivors have an approximately 10-fold risk of mortality compared to the general population or sibling controls, manifesting in a 30% decrease in life-expectancy regardless of age at HCT. [4][5][6][7][8] In HCT survivors, infection is a leading cause of premature mortality, after relapse and graft versus host disease (GVHD). [4][5][6][7][8] Most infections occur during the first year after HCT, and different types of infections predominate at various times during this period.…”

“…[4][5][6][7][8] In HCT survivors, infection is a leading cause of premature mortality, after relapse and graft versus host disease (GVHD). [4][5][6][7][8] Most infections occur during the first year after HCT, and different types of infections predominate at various times during this period. [9][10][11][12][13][14] However, immune reconstitution beyond 1 year is not completely understood.…”

Conditional survival after surgical resection of primary retroperitoneal tumors: a population-based study

“…Conditional survival (CS) is a concept that takes into account changes in survival risk due to extended lifespan and is used to describe dynamic survival probabilities [14][15][16]. Because the risk of death changes over time, CS can provide more accurate information for long-term prognosis and has been used for prognostic evaluation of tumors of the gastrointestinal tract, liver, bone marrow, oral cavity, pancreas, urinary tract, and hematopoietic system, among other locations [17][18][19][20][21][22][23][24][25].…”