Iida Minako, Nakasone Hideki, Yamashita Takuya, Inoue Masami, Ishida Yasushi, Uchiyama Hitoji, Katayama Yuta, Miyamoto Toshihiro, Yoshioka Satoshi, Shiratori Souichi, Mori Takehiko, Sawa Masashi, Sugio Yasuhiro, Fukuda Takahiro, Ichinohe Tatsuo, Atsuta Yoshiko, Inamoto Yoshihiro
Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine,Nagakute, Japan.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Blood Cell Ther. 2020 Feb 25;3(1):11-17. doi: 10.31547/bct-2019-011.
By evaluating risks of late mortality and causes of death among long-term survivors after autologous hematopoietic stem cell transplantation (HSCT) in Japan, we clarified what we should focus on during follow-up to reduce them. The study cohort included 6,780 patients who had survived for ≥2 years after the first autologous HSCT performed from 1974 to 2012 for hematological diseases. With a median follow-up of 6.0 years among survivors, overall survival probabilities at 5 and 10 years after HSCT were 92% and 83%, respectively. Eight hundred thirty deaths occurred: 451, recurrent primary diseases; 87, subsequent solid cancers; 57, subsequent hematological malignancies; 55, infections; 41, respiratory diseases; 19, cardiovascular diseases; 15, liver diseases; 10, neurological diseases; and 7, kidney/genitourinary diseases (Except small numbers of other causes and missing). According to the log-rank test, the risk of overall mortality was remarkably increased among HSCT recipients compared with the that in the general Japanese population (observed/expected ratio [O/E]=5.4; 95% confidence interval [CI], 5.0-5.8). The risks of cause-specific mortality increased with infection (O/E=6.8; 95% CI, 5.1-8.8), subsequent solid cancers (O/E=1.4; 95% CI, 1.1-1.7), subsequent hematological malignancies (O/E=14.3; 95% CI, 10.8-18.5), kidney/genitourinary diseases (O/E=3.4; 95% CI, 1.4-7.1), respiratory disease (O/E=9.0; 95% CI, 6.5-1.2), and liver diseases (O/E=2.6; 95% CI, 1.4-4.2). Long-term survivors after autologous HSCT are at an increased risk of death due to secondary cancers, infections, and any organ diseases as well as recurrence compared to the general population. When monitoring these patients in the outpatient clinic, it is important for physicians to predict a change in the patient's condition and to start treatment earlier.
通过评估日本自体造血干细胞移植（HSCT）后长期存活者的晚期死亡风险和死亡原因，我们明确了在随访期间应重点关注哪些方面以降低这些风险。研究队列包括6780例1974年至2012年因血液系统疾病首次接受自体HSCT后存活≥2年的患者。存活者的中位随访时间为6.0年，HSCT后5年和10年的总生存概率分别为92%和83%。发生了830例死亡：451例为原发性疾病复发；87例为后续实体癌；57例为后续血液系统恶性肿瘤；55例为感染；41例为呼吸系统疾病；19例为心血管疾病；15例为肝脏疾病；10例为神经系统疾病；7例为肾脏/泌尿生殖系统疾病（除少量其他原因和缺失原因外）。根据对数秩检验，与日本普通人群相比，HSCT受者的总死亡风险显著增加（观察/预期比值[O/E]=5.4；95%置信区间[CI]，5.0 - 5.8）。特定原因死亡风险在感染（O/E=6.8；95% CI，5.1 - 8.8）、后续实体癌（O/E=1.4；95% CI，1.1 - 1.7）、后续血液系统恶性肿瘤（O/E=14.3；95% CI，10.8 - 18.5）、肾脏/泌尿生殖系统疾病（O/E=3.4；95% CI，1.4 - 7.1）、呼吸系统疾病（O/E=9.0；95% CI，6.5 - 1.2）和肝脏疾病（O/E=2.6；95% CI，1.4 - 4.2）中增加。与普通人群相比，自体HSCT后的长期存活者因继发性癌症、感染、任何器官疾病以及复发导致的死亡风险增加。在门诊监测这些患者时，医生预测患者病情变化并尽早开始治疗非常重要。
