Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens

Abstract

We analyzed the late outcomes of 429 long-term survivors post allogeneic hematopoietic SCT (allo-HSCT) who received transplant in our center between 1981 and 2002, and were free of their primary disease for X2 years after allo-HSCT. Late recurrent primary malignancy was found in 58 (13.5%) patients and was the primary cause of late death. A total of 37 (8.6%) patients died of nonrelapse causes at a median of 5.5 years (range, 2-15.6 years) post allo-HSCT. The major non-relapse causes of death were chronic GVHD (cGVHD), secondary malignancy and infection. The probabilities of OS and EFS were 85% (95% cumulative incidence (CI) (81-89%)) and 79% (95% CI (74-83%)) at 10 years, respectively. Long-term allo-HSCT survivors were evaluated for late complications (median follow-up, 8.6 years (range, 2.3-22.8 years)). cGVHD was diagnosed in 196 (53.1%) survivors. The endocrine and metabolic complications were hypogonadism in 134 (36.3%) patients, osteopenia/ osteoporosis in 90 (24.4%), dyslipidemia in 33 (8.9%), hypothyroidism in 28 (7.6%) and diabetes in 28 (7.6%). Hypertension was diagnosed in 79 (21.4%), renal impairment in 70 (19.0%), depression in 40 (10.8%) and sexual dysfunction in 33 (8.9%) survivors. We conclude that in patients who receive allo-HSCT as treatment for hematological malignancy and who are free of their original disease 2 years post transplant, mortality is low and the probability of durable remission is high. Lifelong surveillance is recommended.

Late mortality after hematopoietic SCT for a childhood malignancy

“…15 Similarly, numerous other studies in adults have demonstrated that chronic GVHD is a significant risk factor and a major cause of late mortality regardless of infectious complications. 1,3,16,17 As chronic GVHD is less prevalent in children, we observed lower rates of death due to chronic GVHD (only 1.2%) and infections (2.2%) compared with the adult literature. 1,3,4 However, it has been shown that once chronic GVHD occurs, 5 year OS is only 60%.…”

“…18 Second malignant neoplasms have also been demonstrated to be a significant cause of late mortality in adults. 1,16 Survivors of allogeneic HSCT have been shown to be at a 12-fold increased risk of developing another malignancy when compared with the general population. 12 Although the risk for the development of a second malignant neoplasm increases with increasing time from HSCT, we did not find new malignancies to be a major cause of late mortality despite a median follow-up of 10.0 years.…”

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

“…Because these practices are relatively new, their impact on risk for SN is poorly understood. Most studies have shown no association, 22,36,38,41 but they are generally small with limited follow-up.…”

“…17 Among 28,874 patients undergoing allogeneic HCT, those transplanted for chronic myelogenous leukemia (CML) had a lower risk of solid cancers than patients with acute leukemia, 39 but this has not been confirmed in other studies. 37,38 Two studies reported increased SN risks with more advanced disease, including adults with lymphoid malignances undergoing autologous HCT (N=300) 59 and patients with FA undergoing allogeneic HCT (N=795). 69 However, disease status was not associated with SN risk in 1487 pediatric autologous HCT recipients with a variety of primary diagnoses.…”

“…39,125 However, the role of TBI in SN risk remains unresolved, with six publications providing strong evidence of increased SN risk from TBI exposure, 16,17,32,46,49,60 and eight studies failing to identify an association between TBI and SN. 22,24,33,37,38,41,59,69 …”