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Bone Marrow Transplant. 2019 Aug 27. doi: 10.1038/s41409-019-0624-z. [Epub ahead of print]

Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors.

Author information

1
Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland. jstyczynski@cm.umk.pl.
2
Policlinico G.B. Rossi, Verona, Italy.
3
EBMT Data Office, Leiden, The Netherlands.
4
Università di Roma "Tor Vergata", Roma, Italy.
5
Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy.
6
Medical University, Poznań, Poland.
7
Hôpital Henri Mondor, Assistance Publique-Hopitaux de Paris (AP-HP) and Paris-Est-Créteil University, Creteil, France.
8
Karolinska University Hospital, and Karolinska Institutet Stockholm, Stockholm, Sweden.
9
Hadassah University Hospital, Jerusalem, Israel.
10
Hospital de la Princesa, Madrid, Spain.
11
EBMT Activity Survey Office, Hematology, Department of Medicine, University Hospital, Basel, Switzerland.
12
Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany.
13
Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
14
Università Vita-Salute San Raffaele, Milan, Italy.
15
Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
16
Hematology Unit, G. Gaslini Children's Institute, Genova, Italy.
17
Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
18
Leiden University Hospital, Leiden, The Netherlands.
19
Department of Haemato-oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
20
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
21
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
22
Department of Stem Cell Transplantation, University Hospital Eppendorf, Hamburg, Germany.
23
Department of Hematology, Hospital Saint Antoine, Paris, France.
24
Hematology, Medical Faculty, University of Basel, Basel, Switzerland.

Abstract

Information on incidence, and factors associated with mortality is a prerequisite to improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55'668 deaths in 114'491 patients with HSCT (83.7% allogeneic) for leukemia were investigated in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year (intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980-2001) to cohort 2 (2002-2015) in all post-transplant phases after autologous HSCT. After allogeneic HSCT, mortality from infections, GVHD, and toxicity decreased up to 1 year, increased at 5 years; deaths from relapse increased in all post-transplant phases. Infections of unknown origin were the main cause of infectious deaths. Lethal bacterial and fungal infections decreased from cohort 1 to cohort 2, not unknown or mixed infections. Infectious deaths were associated with patient-, disease-, donor type, stem cell source, center, and country- related factors. Their impact varied over the post-transplant phases. Transplant centres have successfully managed to reduce death after HSCT in the early and intermediate post-transplant phases, and have identified risk factors. Late post-transplant care could be improved by focus on groups at risk and better identification of infections of "unknown origin".

PMID:
31455899
DOI:
10.1038/s41409-019-0624-z

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