RESUMEN
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a life-saving procedure for children with a variety of non-malignant conditions. However, these children face an increased risk of late death and incident cancers after HSCT, which may occur many years after their initial HSCT. PROCEDURE: We examined cancer occurrence and late mortality in a population-based cohort of 318 Australian children who underwent allogeneic HSCT for non-malignant disease. Standardized incident ratios (SIRs) and standardized mortality ratios (SMRs) were calculated and compared with population controls. RESULTS: We identified six (1.9%) cancers at a median 9.2 years post-HSCT. Cancer occurred 15 times more frequently than in the general population (SIR 15.4, 95% CI = 6.9-34.2). Of the 198 patients who survived for at least 2 years post-HSCT, 11 (5.6%) died at a median 7.5 years post-HSCT. The mortality rate was 17 times higher than in the general population (SMR 17.5, 95% CI = 9.7-31.2). DISCUSSION: Children transplanted for non-malignant conditions require evidence-based survivorship programs to reduce excess morbidity and mortality.
Asunto(s)
Anemia Aplásica/terapia , Enfermedades de la Médula Ósea/terapia , Enfermedad Injerto contra Huésped/mortalidad , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Hemoglobinuria Paroxística/terapia , Errores Innatos del Metabolismo/terapia , Neoplasias/mortalidad , Enfermedades por Inmunodeficiencia Combinada Ligada al Cromosoma X/terapia , Adolescente , Anemia Aplásica/complicaciones , Australia/epidemiología , Enfermedades de la Médula Ósea/complicaciones , Trastornos de Fallo de la Médula Ósea , Niño , Preescolar , Femenino , Estudios de Seguimiento , Enfermedad Injerto contra Huésped/epidemiología , Enfermedad Injerto contra Huésped/etiología , Hemoglobinuria Paroxística/complicaciones , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Errores Innatos del Metabolismo/complicaciones , Neoplasias/epidemiología , Neoplasias/etiología , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Trasplante Homólogo , Enfermedades por Inmunodeficiencia Combinada Ligada al Cromosoma X/complicacionesRESUMEN
We assessed overall and cause-specific mortality and risk factors for late mortality in a nation-wide population-based cohort of 4547 adult cancer patients who survived 2 or more years after receiving an autologous hematopoietic stem cell transplantation (HSCT) in Australia between 1992 and 2005. Deaths after HSCT were identified from the Australasian Bone Marrow Transplant Recipient Registry and through data linkage with the National Death Index. Overall, the survival probability was 56% at 10 years from HSCT, ranging from 34% for patients with multiple myeloma to 90% for patients with testicular cancer. Mortality rates moved closer to rates observed in the age- and sex-matched Australian general population over time but remained significantly increased 11 or more years from HSCT (standardized mortality ratio, 5.9). Although the proportion of deaths from nonrelapse causes increased over time, relapse remained the most frequent cause of death for all diagnoses, 10 or more years after autologous HSCT. Our findings show that prevention of disease recurrence remains 1 of the greatest challenges for autologous HSCT recipients, while the increasing rates of nonrelapse deaths due to the emergence of second cancers, circulatory diseases, and respiratory diseases highlight the long-term health issues faced by adult survivors of autologous HSCT.