[HTML][HTML] Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors

J Styczyński, G Tridello, L Koster, S Iacobelli… - Bone marrow …, 2020 - nature.com
J Styczyński, G Tridello, L Koster, S Iacobelli, A van Biezen, S van der Werf, M Mikulska…
Bone marrow transplantation, 2020nature.com
Abstract Information on incidence, and factors associated with mortality is a prerequisite to
improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55′ 668
deaths in 114′ 491 patients with HSCT (83.7% allogeneic) for leukemia were investigated
in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year
(intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980–
2001) to cohort 2 (2002–2015) in all post-transplant phases after autologous HSCT. After …
Abstract
Information on incidence, and factors associated with mortality is a prerequisite to improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55′668 deaths in 114′491 patients with HSCT (83.7% allogeneic) for leukemia were investigated in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year (intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980–2001) to cohort 2 (2002–2015) in all post-transplant phases after autologous HSCT. After allogeneic HSCT, mortality from infections, GVHD, and toxicity decreased up to 1 year, increased at 5 years; deaths from relapse increased in all post-transplant phases. Infections of unknown origin were the main cause of infectious deaths. Lethal bacterial and fungal infections decreased from cohort 1 to cohort 2, not unknown or mixed infections. Infectious deaths were associated with patient-, disease-, donor type, stem cell source, center, and country- related factors. Their impact varied over the post-transplant phases. Transplant centres have successfully managed to reduce death after HSCT in the early and intermediate post-transplant phases, and have identified risk factors. Late post-transplant care could be improved by focus on groups at risk and better identification of infections of “unknown origin”.
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