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Leukemia. 2018 Dec 20. doi: 10.1038/s41375-018-0302-y. [Epub ahead of print]

Late treatment-related mortality versus competing causes of death after allogeneic transplantation for myelodysplastic syndromes and secondary acute myeloid leukemia.

Author information

1
Universitaetsklinikum Dresden, Dresden, Germany. Johannes.Schetelig@uniklinikum-dresden.de.
2
DKMS Clinical Trials Unit, Dresden, Germany. Johannes.Schetelig@uniklinikum-dresden.de.
3
DKMS Clinical Trials Unit, Dresden, Germany.
4
Leiden University Medical Center, Leiden, The Netherlands.
5
University Hospital Maastricht, Maastricht, The Netherlands.
6
EBMT Data Office Leiden, Leiden, The Netherlands.
7
University of Freiburg, Freiburg, Germany.
8
University Hospital Leipzig, Leipzig, Germany.
9
University Hospital, Essen, Germany.
10
GKT School of Medicine, London, UK.
11
Universitaetsklinikum Dresden, Dresden, Germany.
12
Hannover Medical School, Hannover, Germany.
13
University Hospital Eppendorf, Hamburg, Germany.
14
University Hospital Gasthuisberg, Leuven, Belgium.
15
Hopital St. Louis, Paris, France.
16
Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
17
University of Münster, Münster, Germany.
18
Heinrich Heine Universität, Düsseldorf, Germany.
19
HUCH Comprehensive Cancer Center, Helsinki, Finland.
20
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
21
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
22
University of Heidelberg, Heidelberg, Germany.
23
Karolinska University Hospital, Stockholm, Sweden.
24
CHU de Lille, LIRIC, INSERM U995, Université de Lille, 59000, Lille, France.

Abstract

The causes and rates of late patient-mortality following alloHCT for myelodysplastic syndromes or secondary acute myeloid leukemia were studied, to assess the contribution of relapse-related, treatment-related, and population factors. Data from EBMT on 6434 adults, who received a first alloHCT from January 2000 to December 2012, were retrospectively studied using combined land-marking, relative-survival methods and multi-state modeling techniques. Median age at alloHCT increased from 49 to 58 years, and the number of patients aged ≥65 years at alloHCT increased from 5 to 17%. Overall survival probability was 53% at 2 years and 35% at 10 years post-alloHCT. Survival probability at 5 years from the 2-year landmark was 88% for patients <45-year old and 63% for patients ≥65-year old at alloHCT. Cumulative incidence of nonrelapse mortality (NRM) for patients <45-year old at transplant was 7% rising to 25% for patients aged ≥65. For older patients, 31% of NRM-deaths could be attributed to population mortality. Favorable post-alloHCT long-term survival was seen; however, excess mortality-risk for all age groups was shown compared to the general population. A substantial part of total NRM for older patients was attributable to population mortality, information which aids the balanced explanation of post-HCT risk and helps improve long-term care.

PMID:
30573777
DOI:
10.1038/s41375-018-0302-y

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