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Br J Haematol. 2016 May;173(3):432-43. doi: 10.1111/bjh.13965. Epub 2016 Feb 23.

A national study on conditional survival, excess mortality and second cancer after high dose therapy with autologous stem cell transplantation for non-Hodgkin lymphoma.

Author information

1
National Advisory Unit on Late Effects, Department of Oncology, Oslo University Hospital, Oslo, Norway.
2
Faculty of Medicine, University of Oslo, Oslo, Norway.
3
Department of Oncology, Oslo University Hospital, Oslo, Norway.
4
Department of Oncology, St. Olavs Hospital, Trondheim, Norway.
5
Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
6
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
7
Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.
8
Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
9
Department of Oncology, University Hospital of North Norway, Tromsø, Norway.
10
Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital Oslo, Oslo, Norway.

Abstract

This national population-based study aimed to investigate conditional survival and standardized mortality ratios (SMR) after high-dose therapy with autologous stem-cell transplantation (HDT-ASCT) for non-Hodgkin lymphoma (NHL), and to analyse cause of death, relapses and second malignancies. All patients ≥18 years treated with HDT-ASCT for NHL in Norway between 1987 and 2008 were included (n = 578). Information from the Cause of Death Registry and Cancer Registry of Norway were linked with clinical data. The 5-, 10- and 20-year overall survival was 61% (95% confidence interval [CI] 56-64%), 52% (95%CI 48-56%) and 45% (95%CI 40-50%), respectively. The 5-year survival conditional on having survived 2, 5 and 10 years after HDT-ASCT was 81%, 86% and 93%. SMRs were 12·3 (95%CI 11·0-13·9), 4·9 (95%CI 4·1-5·9), 2·4 (95%CI 1·8-3·2) and 1·0 (95%CI 0·6-1·8) for the entire cohort and for patients having survived 2, 5 and 10 years after HDT-ASCT respectively. Of the 281 deaths observed, 77% were relapse-related. Treatment-related mortality was 3·6%. The 10-year cumulative incidence of second malignancies was 7·9% and standardized incidence ratio was 2·0 (95%CI 1·5-2·6). NHL patients treated with HDT-ASCT were at increased risk of second cancer and premature death. The mortality was still elevated at 5 years, but after 10 years mortality equalled that of the general population.

KEYWORDS:

NHL; SMR; autologous stem cell transplantation; conditional survival; lymphoma

PMID:
26914167
DOI:
10.1111/bjh.13965
[Indexed for MEDLINE]

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