Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors

Abstract

Information on incidence, and factors associated with mortality is a prerequisite to improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55′668 deaths in 114′491 patients with HSCT (83.7% allogeneic) for leukemia were investigated in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year (intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980-2001) to cohort 2 (2002-2015) in all posttransplant phases after autologous HSCT. After allogeneic HSCT, mortality from infections, GVHD, and toxicity decreased up to 1 year, increased at 5 years; deaths from relapse increased in all post-transplant phases. Infections of unknown origin were the main cause of infectious deaths. Lethal bacterial and fungal infections decreased from cohort 1 to cohort 2, not unknown or mixed infections. Infectious deaths were associated with patient-, disease-, donor type, stem cell source, center, and country-related factors. Their impact varied over the post-transplant phases. Transplant centres have successfully managed to reduce death after HSCT in the early and intermediate post-transplant phases, and have identified risk factors. Late post-transplant care could be improved by focus on groups at risk and better identification of infections of "unknown origin".

Age-dependent determinants of infectious complications profile in children and adults after hematopoietic cell transplantation: lesson from the nationwide study

“…(3) much higher rate of diagnosis of possible IFD in children being the consequence of the positive results of imaging only; (4) higher incidence of viral infections in children, what can correspond to higher rate of primary infections; and finally, (5) real-life tendency of pediatricians to perform more detailed diagnostic procedures. Due to the same factors, the diagnosis of multiple myeloma was associated with a decreased risk for infection in multivariate analysis.…”

“…High viral infection risk after allo-HCT is likely related to the delayed immune reconstitution after transplantation [4]. Recent EBMT (European Society for Blood and Marrow Transplantation) analysis showed that infections are responsible for 21.6% of deaths after allo-HCT and 11.0% after auto-HCT in all age groups together; however, the risk, types, and outcome of infections varied between age groups [5].…”

Haematopoietic stem cell transplantation in adult soft-tissue sarcoma: an analysis from the European Society for Blood and Marrow Transplantation

“… 29–31 Likewise, the outcomes of our cohort compare favourably to the reported PFS and OS of about 4 and 12 months, respectively, of over 2500 STS patients treated with first-line anthracycline-based chemotherapy in trials of the EORTC. 32 33 When taking into account that most of the patients in our study had high grade sarcomas, were transplanted at relapse, and, most importantly, were treated at times when the therapeutic options for STS were much more limited, and TRM of ASCT was higher than today, 34 these results are remarkable.…”

Impact and Intricacies of Bone Marrow Microenvironment in B-cell Lymphomas: From Biology to Therapy

“…A 2019 study that explored the overall health effects of patients following auto-HCT [113] determined that 41% of patients had no severe impairment of the tested domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) while only 2% had all five impairments [113]. In contrast, allo-HCT has significant treatment-related mortality associated with it [114]. While auto-HCT has less of a chance of complications compared to allo-CT, it still may not be the treatment that works for patients and allo-HCT may be necessary eventually [115].…”