Late mortality after hematopoietic SCT for a childhood malignancy

Abstract

Hematopoietic SCT (HSCT) has been used as a curative therapy for pediatric malignancies. Survivors of HSCT are at risk for disease recurrence, late morbidity and mortality. We assessed late mortality (X2 years post-HSCT) in a population-based cohort of children who underwent HSCT for a malignancy. Mortality outcomes were determined by linking a clinical transplant database with the Canadian province of Ontario's pediatric cancer mortality files. Seven hundred and fifty-four children underwent HSCT (371 allogeneic, 383 autologous). Of the 479 (63.5%) who were alive X2 years post HSCT, 98 (20.5%) suffered a late death. Late mortality in the allogeneic HSCT group was 14.9% (median follow-up 10.0 years; range: 2.0-25.6 years), mainly due to relapse of the primary malignancy (64.7%). Chronic GVHD and second malignancies were not major causes of late mortality. A total of 25.5% suffered a late death following autologous HSCT (median follow-up 6.7 years; range: 2.0-22.2 years). Recurrence of the primary malignancy accounted for 87.5% of these deaths. Recurrence of the primary malignancy is the predominant cause of late mortality after HSCT. In contrast to studies of adult patients, non-relapse mortality is less common in children, and death due to chronic GVHD and secondary malignancies is uncommon.

Late mortality after autologous blood or marrow transplantation in childhood: a Blood or Marrow Transplant Survivor Study-2 report

“…Our results are in contrast to those reported by Schechter et al, in which male survivors were 1.8 times more likely to die than females. 4 In concordance with the present study, the SMR for females was almost twice that of males in the study by Ashton et al, although that study was restricted to adult autologous BMT recipients. 1 Our study shows that the increased risk of late mortality among females compared with males was mainly driven by an increased risk of RRM.…”

“…The present study demonstrates that patients who survive 2 or more years after autologous BMT performed before the age of 22 years have an overall survival of 81% and 74%, 5 and 10 years after transplantation, respectively. These numbers are slightly higher than the corresponding overall survival rates of 76% and 71%, respectively, among 2-year survivors of autologous BMT in childhood reported by Schecher et al 4 The difference in distribution of primary diagnoses in the 2 cohorts may contribute to the discrepancy in survival rates, where the study by Schechter et al included a higher proportion of patients with neuroblastoma and CNS tumors and a lower proportion with ALL and lymphomas.…”

“…The SMR of the 251 2-year survivors of autologous BMT reported by Schechter et al was 733. 4 In the latter cohort, 39% had a primary diagnosis of neuroblastoma, and 40% of these suffered a late death. In the current study, patients with neuroblastoma Years after BMT…”

“…In the study by Schechter et al, 57 of the 64 patients who suffered a late death after autologous BMT died as a result of relapse. 4 Also, in cohorts including adult autologous BMT recipients, relapse is the leading cause of death. [1][2][3] In contrast to the present study, in which all late deaths because of relapse occurred within the first decade after transplantation, relapse remained the most frequent cause of death 10 or more years after autologous BMT in a cohort of adult autologous recipients, although the proportion of deaths from nonrelapse causes increased over time.…”

“…However, there is little information regarding the long-term outcome after autologous BMT performed in childhood and whether mortality rates in this population have changed over the past 3 decades. 4 We address the existing gaps in knowledge by examining allcause mortality, relapse-related mortality (RRM), and nonrelapserelated mortality (NRM) in children treated with autologous BMT between 1980 and 2010, permitting assessment of change in late mortality rates over these 3 decades.…”