Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Population Sciences, City of Hope, Duarte, CA.
J Clin Oncol. 2022 Jun 20;40(18):1991-2003. doi: 10.1200/JCO.21.02372. Epub 2022 Mar 9.
We determined trends in life expectancy and cause-specific late mortality after autologous blood or marrow transplantation (BMT) performed over a 30-year period, using the BMT Survivor Study.
We constructed a cohort of 4,702 individuals with hematologic neoplasms who lived ≥ 2 years after autologous BMT performed between 1981 and 2014 at three transplant centers. The end of follow-up was April 19, 2021. The primary exposure variable was autologous BMT performed in four eras: 1981-1999; 2000-2005; 2006-2010; and 2011-2014. Vital status and cause of death were obtained from National Death Index Plus program and Accurinct databases.
The median age at BMT was 53 years (range, 0-78 years), 58.7% were male, 67.8% were non-Hispanic White, and 28.3% had undergone transplantation between 2011 and 2014. Autologous BMT recipients experienced a 7-year reduction in life expectancy. The adjusted hazard of 5-year all-cause mortality declined over the four eras (reference: 1981-1999; hazard ratio [HR] = 0.77; 95% CI, 0.62 to 0.94; HR = 0.64; 95% CI, 0.51 to 0.79; HR = 0.56; 95% CI, 0.45 to 0.71; < .001), as did years of life lost (5.0 years to 1.6 years). The reduction in all-cause mortality was most pronounced among those transplanted for Hodgkin lymphoma or plasma cell dyscrasias, but was not observed among those transplanted for non-Hodgkin lymphoma or those conditioned with total-body irradiation. We also observed a decline in late deaths because of infection ( < .0001; primarily for BMTs before 2006) and subsequent neoplasms ( = .03; confined to decline in therapy-related myeloid neoplasm-related mortality) but not because of cardiovascular or renal disease.
Late mortality among autologous BMT recipients has declined over a 30-year period. However, ongoing efforts are needed to mitigate development of infections, subsequent neoplasms, and cardiovascular and renal disease to further reduce late mortality.
我们通过 BMT 幸存者研究，确定了在 30 年内接受自体血液或骨髓移植（BMT）后预期寿命和特定原因晚期死亡率的趋势。
我们构建了一个队列，该队列由 4702 名患有血液系统恶性肿瘤的个体组成，这些个体在 1981 年至 2014 年期间在三个移植中心接受了自体 BMT 后至少存活 2 年。随访结束日期为 2021 年 4 月 19 日。主要暴露变量是在四个时期进行的自体 BMT：1981-1999 年；2000-2005 年；2006-2010 年；和 2011-2014 年。通过国家死亡指数加计划和 Accurinct 数据库获得生存状态和死因。
BMT 时的中位年龄为 53 岁（范围，0-78 岁），58.7%为男性，67.8%为非西班牙裔白人，28.3%在 2011 年至 2014 年期间接受了移植。自体 BMT 受者预期寿命缩短了 7 年。五个原因的全因死亡率的调整危险比在四个时期均降低（参考：1981-1999 年；危险比[HR] = 0.77；95%CI，0.62 至 0.94；HR = 0.64；95%CI，0.51 至 0.79；HR = 0.56；95%CI，0.45 至 0.71；<0.001），失去的寿命也减少（5.0 年减少到 1.6 年）。全因死亡率的降低在接受霍奇金淋巴瘤或浆细胞疾病治疗的患者中最为明显，但在接受非霍奇金淋巴瘤或接受全身照射的患者中未观察到。我们还观察到感染导致的晚期死亡减少（<0.0001；主要是在 2006 年之前的 BMT）和随后的肿瘤（=0.03；仅限于治疗相关髓系肿瘤相关死亡率的降低），但不是心血管或肾脏疾病导致的。
在 30 年内，自体 BMT 受者的晚期死亡率有所下降。然而，仍需努力降低感染、随后的肿瘤以及心血管和肾脏疾病的发生，以进一步降低晚期死亡率。
