Abstract

Background

Long-term mortality after hematopoietic cell transplantation (HCT) is conventionally calculated from the time of HCT, ignoring temporal changes in survivors’ mortality risks. Conditional survival rates, accounting for time already survived, are relevant for optimal delivery of survivorship care but have not been widely quantified. We estimated conditional survival by elapsed survival time in allogeneic HCT patients and examined cause-specific mortality.

Methods

We calculated conditional survival rates and standardized mortality ratio for overall and cause-specific mortality in 4485 patients who underwent HCT for malignant hematologic diseases at a large transplant center during 1976–2014. Statistical tests were two-sided.

Results

The 5-year survival rate from HCT was 48.6%. After surviving 1, 2, 5, 10, and 15 years, the subsequent 5-year survival rates were 71.2%, 78.7%, 87.4%, 93.5%, and 86.2%, respectively. The standardized mortality ratio was 30.3 (95% confidence interval [CI] = 29.2 to 35.5). Although the standardized mortality ratio declined in longer surviving patients, it was still elevated by 3.6-fold in survivors of 15 years or more (95% CI = 3.0 to 4.1). Primary disease accounted for 50% of deaths in the overall cohort and only 10% in 15-year survivors; the leading causes of nondisease-related mortality were subsequent malignancy (26.1%) and cardiopulmonary diseases (20.2%). We also identified the risk factors for nondisease-related mortality in 1- and 5-year survivors.

Conclusion

Survival probability improves the longer patients survive after HCT. However, HCT recipients surviving 15 years or more remain at elevated mortality risk, largely because of health conditions other than their primary disease. Our study findings help inform preventive and interventional strategies to improve long-term outcomes after allogeneic HCT.

中文翻译：

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异基因造血细胞移植后的条件性生存，特定病因死亡率，晚期死亡率的危险因素。

摘要

背景

造血细胞移植（HCT）后的长期死亡率通常是从HCT时算起的，忽略了幸存者死亡风险的时间变化。有条件的生存率（考虑到已经生存的时间）与最优的生存护理服务有关，但尚未得到广泛的量化。我们通过同种异体HCT患者的生存时间估算出条件生存率，并检查了特定原因的死亡率。

方法

我们计算了1976-2014年间在大型移植中心接受过HCT恶性血液病治疗的4485例患者的条件生存率和标准死亡率，以总死亡率和特定原因死亡率进行了计算。统计检验是双面的。

结果

HCT的5年生存率为48.6％。在分别生存了1、2、5、10和15年之后，随后的5年生存率分别为71.2％，78.7％，87.4％，93.5％和86.2％。标准化死亡率为30.3（95％置信区间[CI] = 29.2至35.5）。尽管标准的死亡率在较长的存活患者中有所下降，但在15岁或以上的存活者中仍然达到3.6倍（95％CI = 3.0至4.1）。原发性疾病占整个队列死亡的50％，而15岁幸存者仅占10％。非疾病相关死亡率的主要原因是随后的恶性肿瘤（26.1％）和心肺疾病（20.2％）。我们还确定了1年和5年幸存者中非疾病相关死亡率的危险因素。

结论

生存概率提高了HCT后患者生存的时间。但是，存活15年以上的HCT接受者仍然处于较高的死亡风险中，这主要是由于其原发疾病以外的健康状况。我们的研究结果有助于为预防和干预策略提供信息，以改善异基因HCT后的长期预后。