Chow Eric J, Cushing-Haugen Kara L, Cheng Guang-Shing, Boeckh Michael, Khera Nandita, Lee Stephanie J, Leisenring Wendy M, Martin Paul J, Mueller Beth A, Schwartz Stephen M, Baker K Scott
Eric J. Chow, Kara L. Cushing-Haugen, Guang-Shing Cheng, Michael Boeckh, Stephanie J. Lee, Wendy M. Leisenring, Paul J. Martin, Beth A. Mueller, Stephen M. Schwartz, and K. Scott Baker, Fred Hutchinson Cancer Research Center; Eric J. Chow, Guang-Shing Cheng, Michael Boeckh, Stephanie J. Lee, Paul J. Martin, Beth A. Mueller, Stephen M. Schwartz, and K. Scott Baker, University of Washington, Seattle, WA; and Nandita Khera, Mayo Clinic, Scottsdale, AZ.
J Clin Oncol. 2017 Jan 20;35(3):306-313. doi: 10.1200/JCO.2016.68.8457. Epub 2016 Nov 21.
Purpose To compare the risks of serious health outcomes among hematopoietic cell transplantation (HCT) survivors versus a matched population of patients with cancer who did not undergo HCT, where the primary difference may be exposure to HCT. Methods Two-year HCT survivors treated at a comprehensive cancer center from 1992 through 2009 who were Washington State residents (n = 1,792; 52% allogeneic and 90% hematologic malignancies) were frequency matched by demographic characteristics and underlying cancer diagnosis (as applicable) to non-HCT 2-year cancer survivors, using the state cancer registry (n = 5,455) and the general population (n = 16,340) using driver's license files. Late outcomes for all three cohorts were ascertained from the state hospital discharge and death registries; subsequent cancers were ascertained from the state cancer registry. Results After median follow-up of 7.1 years, HCT survivors experienced significantly greater rates of hospitalization compared with matched non-HCT cancer survivors (280 v 173 episodes per 1,000 person-years, P < .001) and greater all-cause mortality (hazard ratio [HR], 1.1; 95% CI, 1.01 to 1.3). HCT survivors had more hospitalizations or death with infections (10-year cumulative incidence, 31% v 22%; HR, 1.4; 95% CI, 1.3 to 1.6) and respiratory complications (cumulative incidence, 27% v 20%; HR, 1.4; 95% CI, 1.2 to 1.5). Risks of digestive, skin, and musculoskeletal complications also were greater among HCT versus non-HCT cancer survivors. The two groups had similar risks of circulatory complications and second cancers. Both HCT and non-HCT cancer survivors had significantly greater 10-year cumulative incidences of all major organ-system outcomes versus the general population. Conclusion History of HCT was associated with late morbidity and mortality among cancer survivors. In particular, clinicians who care for HCT survivors should be aware of their high rates of late respiratory and infectious complications.
目的 比较造血细胞移植（HCT）幸存者与未接受HCT的匹配癌症患者群体中严重健康结局的风险，两者的主要差异可能在于是否接受HCT。方法 1992年至2009年在一家综合癌症中心接受治疗的华盛顿州居民HCT幸存者（n = 1792；52%为异基因移植，90%为血液系统恶性肿瘤），根据人口统计学特征和潜在癌症诊断（如适用），与非HCT的2年癌症幸存者进行频数匹配，使用州癌症登记处（n = 5455）和驾照档案中的普通人群（n = 16340）。所有三个队列的晚期结局通过州医院出院和死亡登记处确定；后续癌症通过州癌症登记处确定。结果 中位随访7.1年后，HCT幸存者与匹配的非HCT癌症幸存者相比，住院率显著更高（每1000人年280次对173次，P <.001），全因死亡率也更高（风险比[HR]，1.1；95%可信区间，1.01至1.3）。HCT幸存者因感染导致住院或死亡的情况更多（10年累积发病率，31%对22%；HR，1.4；95%可信区间，1.3至1.6），呼吸并发症也更多（累积发病率，27%对20%；HR，1.4；95%可信区间，1.2至1.5）。与非HCT癌症幸存者相比，HCT幸存者出现消化、皮肤和肌肉骨骼并发症的风险也更高。两组循环系统并发症和二次癌症的风险相似。与普通人群相比，HCT和非HCT癌症幸存者所有主要器官系统结局的10年累积发病率均显著更高。结论 HCT病史与癌症幸存者的晚期发病率和死亡率相关。特别是，照顾HCT幸存者的临床医生应意识到他们晚期呼吸和感染并发症的高发生率。
