Trends in Late Mortality and Life Expectancy After Autologous Blood or Marrow Transplantation Over Three Decades: A BMTSS Report

Abstract

PURPOSE We determined trends in life expectancy and cause-specific late mortality after autologous blood or marrow transplantation (BMT) performed over a 30-year period, using the BMT Survivor Study. METHODS We constructed a cohort of 4,702 individuals with hematologic neoplasms who lived ≥ 2 years after autologous BMT performed between 1981 and 2014 at three transplant centers. The end of follow-up was April 19, 2021. The primary exposure variable was autologous BMT performed in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurinct databases. RESULTS The median age at BMT was 53 years (range, 0-78 years), 58.7% were male, 67.8% were non-Hispanic White, and 28.3% had undergone transplantation between 2011 and 2014. Autologous BMT recipients experienced a 7-year reduction in life expectancy. The adjusted hazard of 5-year all-cause mortality declined over the four eras (reference: 1981-1999; hazard ratio [HR]2000-2005 = 0.77; 95% CI, 0.62 to 0.94; HR2006-2010 = 0.64; 95% CI, 0.51 to 0.79; HR2011-2014 = 0.56; 95% CI, 0.45 to 0.71; Ptrend < .001), as did years of life lost (5.0 years to 1.6 years). The reduction in all-cause mortality was most pronounced among those transplanted for Hodgkin lymphoma or plasma cell dyscrasias, but was not observed among those transplanted for non-Hodgkin lymphoma or those conditioned with total-body irradiation. We also observed a decline in late deaths because of infection ( Ptrend < .0001; primarily for BMTs before 2006) and subsequent neoplasms ( Ptrend = .03; confined to decline in therapy-related myeloid neoplasm–related mortality) but not because of cardiovascular or renal disease. CONCLUSION Late mortality among autologous BMT recipients has declined over a 30-year period. However, ongoing efforts are needed to mitigate development of infections, subsequent neoplasms, and cardiovascular and renal disease to further reduce late mortality.

Clinical significance of clonal hematopoiesis in the setting of autologous stem cell transplantation for lymphoma

“…The causes of morbidity and mortality associated with CH mirror the common causes of non‐relapse mortality generally seen after ASCT. Indeed, in a recent retrospective study of over 4700 patients who survived for at least 2 years after ASCT, the most common causes of non‐relapse mortality were infections, secondary malignancies, cardiovascular, and renal disease 40 . Consequently, the life expectancy of transplant recipients was reduced by seven years compared to the general population.…”

“…Indeed, in a recent retrospective study of over 4700 patients who survived for at least 2 years after ASCT, the most common causes of non-relapse mortality were infections, secondary malignancies, cardiovascular, and renal disease. 40 Consequently, the life expectancy of transplant recipients was reduced by seven years compared to the general population. The authors found that the all-cause mortality improved in the modern eras, whereas no such improvement was observed for patients with non-Hodgkin lympho.…”

Cardiovascular disease and chimeric antigen receptor cellular therapy

“…While there has been a consistent trend of improvement in the survival following both autologous and allogeneic hematopoietic cell transplantation bone marrow transplant therapies decade over decade (47,48), cardiovascular toxicities (49) continue to be frequent complications, along with infections and graft vs. host disease. This has resulted in evolving practice guidelines targeting preventive evaluations pretransplant, monitoring peri-transplant, and surveillance in long term survivors (50,51).…”

Living Long and Well After an Autograft

“…In the article that accompanies this editorial, 1 the authors representing the Bone Marrow Transplant Survivor Study have extended previous work evaluating outcomes in more than 4,000 patients of all ages (median age, 53 years; range, 0-78 years) surviving for at least 2 years after an autograft for hematologic malignancies in four eras spanning 1981-2014. This timely study provides valuable information when counseling autograft patients about long-term nonrelapse outcomes.…”

“…In the article that accompanies this editorial, the authors 1 representing the Bone Marrow Transplant Survivor Study (a collaboration between City of Hope and the University of Minnesota and, more recently, the University of Alabama) have extended their previous work in children 2 by including 4,702 patients of all ages (median age, 53 years; range, 0-78 years) after an autograft for hematologic malignancies in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014 (Fig 1). 1 The study focuses on outcomes in patients surviving at least 2 years, and comparison across the eras was restricted to 5 years of follow-up to ensure adequate follow-up from the most current era. Unsurprising observations include the reduction in the use of total-body irradiation (TBI) in conditioning (56% to 5%), and the switch from a mixture of marrow and peripheral blood stem cells (PBPCs) as the source of reconstitution originally to almost 100% PBPCs since 2000.…”