Increase of suicide and accidental death after hematopoietic stem cell transplantation

Abstract

BACKGROUNDRelapse 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.METHODSThe 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.RESULTSThe 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).CONCLUSIONSThere 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. Cancer 2013;119:2012–2021. © 2013 American Cancer Society.

Suicidal ideation in lung transplant recipients: A case series

“…An examination of the incidence of suicide after hematopoietic stem cell transplantation demonstrated an excess of deaths due to suicide compared with the general population (20.7 vs 9.2 deaths per 100 000 person‐years, respectively), consistent with similar investigations . The prevalence of chronic graft‐vs‐host disease and relapses was significantly more frequent among patients who died from suicide, and overall risk factors for death related to suicide were male sex and older age.…”

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report

“…Depressed mood warrants careful regular monitoring because it is the principal factor associated with suicidal ideation, it is associated with multiple other negative outcomes, and can be effectively treated [152]. The risk of suicide is greater in HCT survivors compared with that in the general population, and among allogeneic HCT survivors, chronic GVHD increases this risk by almost 3-fold [164,165]. …”

Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care

“…In a study on severe chronic GVHD after HCT with nonmyeloablative conditioning, 5% of the patients needed hospitalization because of suicidal ideation related to their GVHD [90]. In a large population-based cohort study, the cumulative incidence at 10 years for suicide deaths increased up to 100 per 100,000 patients for both allogeneic and autologous HCT recipients [91]. The standard mortality rate and the absolute excess rate of death by suicide were higher with 2.12 (95% confidence interval, 1.83 to 2.45) and 20.91, respectively, compared with the general population.…”