In an analysis from the BMT Survivor Study reported in the Journal of Clinical Oncology, Smita Bhatia, MD, MPH, and colleagues assessed late mortality over a 30-year period among patients who underwent autologous blood or marrow transplantation (BMT) for hematologic malignancies. They found an overall 7-year decrease in life expectancy, although the risk of 5-year overall mortality has significantly decreased over time.
Study Details
The analysis involved a cohort of 4,702 patients who lived for at least 2 years after autologous BMT performed between 1981 and 2014 at three U.S. transplant centers. The end of follow-up was in April 2021. The cohort consisted of 1,048 patients undergoing BMT in the period of 1981 to 1999; 1,108 from 2000 to 2005; 1,215 from 2006 to 2010; and 1,331 from 2011 to 2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurint databases.
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.— Smita Bhatia, MD, MPH, and colleagues
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Key Findings
Median age at the time of BMT was 53 years. Conditioned on survival 2 years after BMT, the 25-year overall survival was 41.0%. Mortality rates remained elevated for patients who had survived ≥ 30 years after BMT compared with the general population, with the excess equaling a 7-year reduction in life expectancy.
Compared with 1981 to 1999, adjusted hazard ratios (HRs) for 5-year all-cause mortality were 0.77 (95% confidence interval [CI] = 0.62–0.94) for 2000 to 2005, 0.64 (95% CI = 0.51–0.79) for 2006 to 2010, and 0.56 (95% CI = 0.45–0.71) for 2011 to 2014 (P for trend < .001). Years of life lost decreased from 5.0 to 3.0, 2.2, and 1.6 across the four periods, respectively. Analysis stratified by primary diagnosis showed declines in all-cause mortality for patients with Hodgkin lymphoma and plasma cell dyscrasias, but not for those with non-Hodgkin lymphoma or acute myeloid leukemia/myelodysplastic syndrome.
The most common causes of non–recurrence-related mortality were infection (n = 361), subsequent malignant neoplasms (n = 346), cardiovascular disease (n = 260), and renal disease (n = 165). Decreases in risk of causes of 5-year mortality compared with 1981 to 1999 were observed for infection (P for trend < .0001, primarily reflecting decline during 2000–2005; HRs = 0.44, 0.39, and 0.41 for 2000–2005, 2006–2010, and 2011–2014) and for subsequent malignant neoplasms (P for trend = .03; confined to decline in therapy-related myeloid neoplasm–related mortality; HRs = 0.56, 0.52, and 0.51). No significant decreases compared with 1981 to 1999 were observed for death due to cardiovascular causes (P for trend = .8) or death due to renal disease (P for trend = .07).
The investigators concluded, “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.”
Dr. Bhatia, of the Institute for Cancer Outcomes and Survivorship, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute and Leukemia and Lymphoma Society. For full disclosures of the study authors, visit ascopubs.org.
