Division of Hematology, University Hospital Basel, Basel, Switzerland.
Cancer. 2013 Jun 1;119(11):2012-21. doi: 10.1002/cncr.27987. Epub 2013 Mar 19.
Relapse and transplant-related complications are leading causes of mortality after hematopoietic stem cell transplantation (HSCT). Suicides and accidents have not been studied in these patients. This study sought to determine whether there is an excess of suicide and accidental deaths after HSCT, and to determine risk factors.
The incidence of suicidal and accidental death in patients after undergoing HSCT, standardized mortality ratio (SMR), and absolute excess risk (AER) of suicide and accidental deaths was determined, compared with the general European population. A case-control analysis was done to define factors associated with suicide and accidental deaths. Data were derived from the European Group for Blood and Marrow Transplantation Registry, including 294,922 patients who underwent autologous or allogeneic HSCT from 1980 to 2009.
The 10-year cumulative incidence of suicide and accidental deaths was 101.8 and 55.6 per 100,000 patients, respectively. SMR and AER of suicide after HSCT were 2.12 (P < .001) and 10.91, higher than in the European general population for 100,000 deaths, respectively. SMR and AER of accidental death were 1.23 (P < .05) and 2.54, respectively. In the case-control study, relapses were more frequent among patients who committed suicide after autologous HSCT (37% versus 18%; P < .0001). Chronic graft-versus-host disease was higher among patients who committed suicide after allogeneic HSCT (64% versus 37%; P = .001).
There is an excess of deaths due to suicide and accidents in patients after undergoing HSCT as compared with the European general population. Relapse was associated with more suicide and accidental deaths after autologous HSCT, and chronic graft-versus-host disease was associated with more deaths by suicide after allogeneic HSCT.
复发和与移植相关的并发症是造血干细胞移植（HSCT）后导致死亡的主要原因。在这些患者中，自杀和意外事故尚未得到研究。本研究旨在确定 HSCT 后患者是否存在自杀和意外死亡的风险增加，并确定相关危险因素。
通过比较欧洲普通人群，确定接受 HSCT 后患者自杀和意外死亡的发生率、标准化死亡率比（SMR）和自杀及意外死亡的绝对超额风险（AER）。采用病例对照分析方法确定与自杀和意外死亡相关的因素。数据来自欧洲血液和骨髓移植协会注册中心，共纳入 1980 年至 2009 年间接受自体或异基因 HSCT 的 294922 例患者。
10 年内自杀和意外死亡的累积发生率分别为 101.8 和 55.6/10 万患者。HSCT 后自杀的 SMR 和 AER 分别为 2.12（P<0.001）和 10.91，高于欧洲普通人群每 10 万人死亡数。意外死亡的 SMR 和 AER 分别为 1.23（P<0.05）和 2.54。在病例对照研究中，自体 HSCT 后自杀患者的复发率更高（37%比 18%；P<0.0001）。异体 HSCT 后自杀患者慢性移植物抗宿主病的发生率更高（64%比 37%；P=0.001）。
与欧洲普通人群相比，HSCT 后患者因自杀和意外死亡的人数过多。自体 HSCT 后复发与更多的自杀和意外死亡相关，而异体 HSCT 后慢性移植物抗宿主病与更多的自杀死亡相关。
