Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study

Bhatia, Smita; Francisco, Liton; Carter, Andrea; Sun, Can Lan; Baker, K. Scott; Gurney, James G.; McGlave, Philip B.; Nademanee, Auayporn; O’Donnell, Margaret; Ramsay, Norma K.C.; Robison, Leslie L.; Snyder, David S.; Stein, Anthony S.; Forman, Stephen J.; Weisdorf, Daniel J.

doi:10.1182/blood-2007-03-082933

Cited by 483 publications

(397 citation statements)

References 21 publications

(21 reference statements)

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“…4 Infectious diseases have been suggested to be a consequence of intensive or secondary chemotherapy, mediastinal radiation and allogenic stem cell transplantations. [29][30][31] The SMRs due to external causes lacked significance among both, siblings and cancer survivors, which is in line with previous publications concerning childhood cancer survivors. 6,7 However, the cancer survivors as well as siblings were more likely to die from other death causes compared to the general population (SMR 2.7, 95% CI 2.3-3.1 among all cancer survivors and SMR 1.7, 95% CI 1.5-1.8 among siblings, respectively) like in earlier studies.…”

Section: Epidemiologysupporting

confidence: 89%

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Kero

Järvelä

Arola

et al. 2014

Intl Journal of Cancer

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To date, only few studies have been published documenting late mortality among early onset cancer survivors, especially regarding young adulthood (YA) malignancies. Our nation-wide population-based registry study provides information concerning cause-specific long-term mortality among 16,769 5-year survivors of early onset cancer (aged 0-34 years at diagnosis), with follow-up for death extending from 1971 through 2012. A sibling cohort and population data were used as reference. The overall standardized mortality ratio (SMR) of cancer patients was 4.6-fold, (95% CI 4.4-4.8). Highest SMRs were found for malignancies (12.8,3), infectious (4.8, 95%CI 2.9-6.7) and cardiovascular diseases (1.9, 95% CI 1.7-2.1). Malignancies and cardiovascular diseases accounted for the largest number of deaths. Childhood and YA cancer survivors with the same primary cancer site had a similarly elevated overall SMR with the exception of markedly higher SMRs after childhood Hodgkin lymphoma. The highest cumulative non-malignancy-related mortality was due to cardiovascular disease with a steady rise throughout the follow-up, but strongly dependent on the primary cancer site and age at diagnosis. In childhood cancer survivors, the cumulative cardiovascular mortality did not reduce over time. However, overall and malignancyrelated mortality showed a declining tendency towards the most recent periods after both, childhood and YA cancer. Our findings on non-malignancy-related mortality stress the need to set up long-term individual follow-up with a focus on cardiovascular late effects for early onset cancer survivors, especially for YA cancer survivors still lacking those.Advances in therapies for early onset cancer have lead to a substantial increase in 5-year survival rates. 1-3 Thus far the main focus of late effect research has been on the morbidity and mortality of childhood cancer survivors aged up to 21 years at cancer diagnosis. [4][5][6][7][8][9] Only few studies have investigated those topics for the survivors of young adult (YA) cancer patients aged from 20 to 34 years at cancer diagnosis. [10][11][12] Previous studies have found elevated risks for chronic health conditions which contribute to higher mortality among survivors of childhood cancer patients compared to the general population. 5,9,13,14 Patterns of increased excess mortality after childhood cancer have been shown to be dependent on time from cancer diagnosis and cause of death. 4,7,11 The success of improved cancer survival is overshadowed by the life-threatening chronic health outcomes that cancer survivors are more likely to suffer from. Thus, the growing population of early onset cancer survivors has a strong need for adequate individualized follow-up to detect and possibly reduce treatment-related morbidities and mortality. 15 After the survival of childhood cancer, the adoption of a healthy lifestyle including physical activity may lower especially the risk of developing late cardiovascular sequelae. 16 Thus, promoting the control of known cardiovascular risk fa...

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Section: Epidemiologysupporting

confidence: 89%

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Kero

Järvelä

Arola

et al. 2014

Intl Journal of Cancer

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“…However, this issue cannot be disregarded especially when chemotherapeutic approaches and/or autologous HSCT, which 15 are associated with less morbidity continue to improve outcome in intermediate risk AML (15)(16)(17)(18). Several studies in recipients of alloHSCT have addressed the issue of late morbidity and late mortality occurring in patients, who were alive and well at 2 years after alloHSCT (102)(103)(104)(105)(106). A relative increase of 20% mortality, gradually occurring during the ensuing 2 decades, has been reported when comparing alloHSCT recipients with age matched controls.…”

Section: Adverse Effects Beyond 2 Years After Transplantation and Quamentioning

confidence: 99%

The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach

et al. 2012

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Allogeneic hematopoietic stem cell transplantation (alloHSCT) is frequently applied as part of treatment in acute myeloid leukemia (AML) in first or subsequent remission. It reduces relapse, but non-relapse mortality (NRM) and morbidity may counterbalance that beneficial effect. Here we review recent studies reporting new disease specific prognostic markers as well as alloHSCT related risk factors to be identified at specific time points during treatment. We propose risk assessment as a dynamic process during treatment, incorporating both disease and transplant related factors for the decision to proceed either to alloHSCT or with a non transplant strategy, whereby alloHSCT may be favored if projected disease free survival can be expected to be improved by at least 10%, based on individual risk assessment. Pivotal for such an approach are initial disease risk assessment, search for a sibling or unrelated donor early after diagnosis, and the incorporation of time dependent risk factors, all within the context of an integrated therapeutic management approach.4

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“…Due to improvement of the transplant procedure and increase of the number of transplantations performed, the number of long-term survivors is constantly increasing. [1][2][3] Allogeneic HSCT remains nevertheless associated with considerable acute and long-term comorbidities, such as GVHD, organ dysfunction and secondary malignancies. Due to improved survival, a number of less severe symptoms and late effects are of increasing importance; thus sicca symptoms arise as a relevant issue potentially harmful for the quality of life (QoL) of the long-term survivors.…”

Section: Introductionmentioning

confidence: 99%

Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT

Daikeler

Mauramo

Rovó

et al. 2013

Bone Marrow Transplant

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The objective of this prospective cross-sectional case-control study was to examine the prevalence of dryness symptoms and its impact on quality of life (QoL) among very long-term survivors after hematopoietic SCT (HSCT) in comparison with their respective sibling donors. Forty-four allogeneic HSCT recipients with a long-term survival (median: 17.5; range: 11-26 years) were included. Their respective, HLA-identical sibling donors served as controls. Clinical examinations included saliva flow rates (SFR) and the Schirmer's test. The presence of sicca symptoms of mouth, eyes and skin were inquired. The social functioning (SF)-36 questionnaire was applied. Recipients had lower (Po0.01) unstimulated and stimulated mean SFR than donors. Schirmer's test results o5 mm was found in 45% of the recipients in comparison with 27% of the donors (P ¼ 0.07). Xerostomia (34 vs 4 subjects), xerophtalmia (23 vs 3) and dry skin (32 vs 12) were reported more often by the recipients than donors (Po0.001). Sicca symptoms and their objective findings correlated with QoL. The mean SF-36 scores of the donors were significantly higher than those of the recipients for physical component summary. In conclusion, sicca symptoms are common amongst long-term survivors of HSCT and affect remarkably the QoL.

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Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study

Cited by 483 publications

References 21 publications

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

Late mortality among 5‐year survivors of early onset cancer: A population‐based register study

The European LeukemiaNet AML Working Party consensus statement on allogeneic HSCT for patients with AML in remission: an integrated-risk adapted approach

Sicca symptoms and their impact on quality of life among very long-term survivors after hematopoietic SCT

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