Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Allografting

Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens

Bone Marrow Transplantation volume 45, pages 295–302 (2010)Cite this article

Abstract

We analyzed the late outcomes of 429 long-term survivors post allogeneic hematopoietic SCT (allo-HSCT) who received transplant in our center between 1981 and 2002, and were free of their primary disease for ⩾2 years after allo-HSCT. Late recurrent primary malignancy was found in 58 (13.5%) patients and was the primary cause of late death. A total of 37 (8.6%) patients died of non-relapse causes at a median of 5.5 years (range, 2–15.6 years) post allo-HSCT. The major non-relapse causes of death were chronic GVHD (cGVHD), secondary malignancy and infection. The probabilities of OS and EFS were 85% (95% cumulative incidence (CI) (81–89%)) and 79% (95% CI (74–83%)) at 10 years, respectively. Long-term allo-HSCT survivors were evaluated for late complications (median follow-up, 8.6 years (range, 2.3–22.8 years)). cGVHD was diagnosed in 196 (53.1%) survivors. The endocrine and metabolic complications were hypogonadism in 134 (36.3%) patients, osteopenia/osteoporosis in 90 (24.4%), dyslipidemia in 33 (8.9%), hypothyroidism in 28 (7.6%) and diabetes in 28 (7.6%). Hypertension was diagnosed in 79 (21.4%), renal impairment in 70 (19.0%), depression in 40 (10.8%) and sexual dysfunction in 33 (8.9%) survivors. We conclude that in patients who receive allo-HSCT as treatment for hematological malignancy and who are free of their original disease 2 years post transplant, mortality is low and the probability of durable remission is high. Lifelong surveillance is recommended.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Horowitz MM, Rowlings PA . An update from the International Bone Marrow Transplant Registry and the Autologous Blood and Marrow Transplant Registry on current activity in hematopoietic stem cell transplantation. Curr Opin Hematol 1997; 4: 395–400.

    Article  CAS  PubMed  Google Scholar 

  2. Zittoun RA, Mandelli F, Willemze R, de Witte T, Labar B, Resegotti L et al. Autologous or allogeneic bone marrow transplantation compared with intensive chemotherapy in acute myelogenous leukemia. European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Leukemia Cooperative Groups. N Engl J Med 1995; 332: 217–223.

    Article  CAS  PubMed  Google Scholar 

  3. Barrett AJ, Horowitz MM, Gale RP, Biggs JC, Camitta BM, Dicke KA et al. Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival. Blood 1989; 74: 862–871.

    CAS  PubMed  Google Scholar 

  4. Passweg JR, Perez WS, Eapen M, Camitta BM, Gluckman E, Hinterberger W et al. Bone marrow transplants from mismatched related and unrelated donors for severe aplastic anemia. Bone Marrow Transplant 2006; 37: 641–649.

    Article  CAS  PubMed  Google Scholar 

  5. Horowitz MM . Uses and growth of hematopoietic cell transplantation. In: Blume KG, Forman SJ, Appelbaum FR (eds). Thomas' Hematopoietic Cell Transplantation, 3rd edn. Blackwell: Malden, MA, 2004, pp 9–15.

    Google Scholar 

  6. Kolb HJ, Bender-Gotze C . Late complications after allogeneic bone marrow transplantation for leukaemia. Bone Marrow Transplant 1990; 6: 61–72.

    CAS  PubMed  Google Scholar 

  7. Deeg HJ . Delayed complications and long-term effects after bone marrow transplantation. Hematol Oncol Clin North Am 1990; 4: 641–657.

    Article  CAS  PubMed  Google Scholar 

  8. Socie G, Stone JV, Wingard JR, Weisdorf D, Henslee-Downey PJ, Bredeson C et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med 1999; 341: 14–21.

    Article  CAS  PubMed  Google Scholar 

  9. Sullivan KM, Mori M, Sanders J, Siadak M, Witherspoon RP, Anasetti C et al. Late complications of allogeneic and autologous marrow transplantation. Bone Marrow Transplant 1992; 1 (suppl 10): 127–134.

    Google Scholar 

  10. Michallet M, Thomas X, Vernant JP, Kuentz M, Socie G, Esperou-Bourdeau H et al. Long-term outcome after allogeneic hematopoietic stem cell transplantation for advanced stage acute myeloblastic leukemia: a retrospective study of 379 patients reported to the Societe Francaise de Greffe de Moelle (SFGM). Bone Marrow Transplant 2000; 26: 1157–1163.

    Article  CAS  PubMed  Google Scholar 

  11. Kolb HJ, Guenther W, Duell T, Socie G, Schaeffer E, Holler E et al. Cancer after bone marrow transplantation. IBMTR and EBMT/EULEP Study Group on Late Effects. Bone Marrow Transplant 1992; 1 (suppl 10): 135–138.

    Google Scholar 

  12. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ . Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol 2005; 23: 6596–6606.

    Article  PubMed  Google Scholar 

  13. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol 2005; 23: 599–608.

    Article  PubMed  Google Scholar 

  14. Kaplan EL, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  15. Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic-graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.

    Article  CAS  PubMed  Google Scholar 

  16. Cox DR . Regression models and life tables. J R Stat Soc 1972; 34: 187–220.

    Google Scholar 

  17. Kiss TL, Abdolell M, Jamal N, Minden MD, Lipton JH, Messner HA . Long-term medical outcomes and quality-of-life assessment of patients with chronic myeloid leukemia followed at least 10 years after allogeneic bone marrow transplantation. J Clin Oncol 2002; 20: 2334–2343.

    Article  CAS  PubMed  Google Scholar 

  18. Robin M, Guardiola P, Devergie A, Yeshurun M, Shapiro S, Esperou H et al. A 10-year median follow-up study after allogeneic stem cell transplantation for chronic myeloid leukemia in chronic phase from HLA-identical sibling donors. Leukemia 2005; 19: 1613–1620.

    Article  CAS  PubMed  Google Scholar 

  19. Hasegawa W, Pond GR, Rifkind JT, Mesner HA, Lau A, Daly AS et al. Long-term follow-up of secondary malignancies in adults after allogeneic bone marrow transplantation. Bone Marrow Transplant 2005; 35: 51–55.

    Article  CAS  PubMed  Google Scholar 

  20. Kolb HJ, Socie G, Duell T, Van Lint MT, Tichelli A, Apperley JF et al. Malignant neoplasms in long-term survivors of bone marrow transplantation. Late Effects Working Party of the European Cooperative Group for Blood and Marrow Transplantation and the European Late Effect Project Group. Ann Intern Med 1999; 131: 738–744.

    Article  CAS  PubMed  Google Scholar 

  21. Lowsky R, Lipton J, Fyles G, Minden M, Meharchand J, Tejpar I et al. Secondary malignancies after bone marrow transplantation in adults. J Clin Oncol 1994; 2: 2187–2192.

    Article  Google Scholar 

  22. Socie G, Curtis RE, Deeg HJ, Sobocinski KA, Filipovich AH, Travis LB et al. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia. J Clin Oncol 2000; 18: 348–357.

    Article  CAS  PubMed  Google Scholar 

  23. Deeg HJ, Socie G, Schoch G, Henry-Amar M, Witherspoon RP, Devergie A et al. Malignancies after marrow transplantation for aplastic anemia and fanconi anemia: a joint Seattle and Paris analysis of results in 700 patients. Blood 1996; 87: 386–392.

    CAS  PubMed  Google Scholar 

  24. Deeg HJ, Witherspoon RP . Risk factors for the development of secondary malignancies after marrow transplantation. Hematol Oncol Clin North Am 1993; 7: 417–429.

    Article  CAS  PubMed  Google Scholar 

  25. Zager RA, O'Quigley J, Zager BK, Alpers CE, Shulman HM, Gamelin LM et al. Acute renal failure following bone marrow transplantation: a retrospective study of 272 patients. Am J Kidney Dis 1989; 13: 210–216.

    Article  CAS  PubMed  Google Scholar 

  26. Antignac C, Gubler MC, Leverger G, Broyer M, Habib R . Delayed renal failure with extensive mesangiolysis following bone marrow transplantation. Kidney Int 1989; 35: 1336–1344.

    Article  CAS  PubMed  Google Scholar 

  27. Lawton CA, Cohen EP, Barber-Derus SW, Murray KJ, Ash RC, Casper JT et al. Late renal dysfunction in adult survivors of bone marrow transplantation. Cancer 1991; 67: 2795–2800.

    Article  CAS  PubMed  Google Scholar 

  28. Ghobrial IM, Bunch TJ, Caplice NM, Edwards WD, Miller DV, Litzow MR . Fatal coronary artery disease after unrelated donor bone marrow transplantation. Mayo Clin Proc 2004; 79: 403–406.

    Article  PubMed  Google Scholar 

  29. Tichelli A, Bucher C, Rovó A, Stussi G, Stern M, Paulussen M et al. Premature cardiovascular disease after allogeneic hematopoietic stem-cell transplantation. Blood 2007; 110: 3463–3471.

    Article  CAS  PubMed  Google Scholar 

  30. Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood 2007; 109: 1765–1772.

    Article  CAS  PubMed  Google Scholar 

  31. Tauchmanova L, Selleri C, Rosa GD, Pagano L, Orio F, Lombardi G et al. High prevalence of endocrine dysfunction in long-term survivors after allogeneic bone marrow transplantation for hematologic diseases. Cancer 2002; 95: 1076–1084.

    Article  PubMed  Google Scholar 

  32. Spinelli S, Chiodi S, Bacigalupo A, Brasca A, Menada MV, Petti AR et al. Ovarian recovery after total body irradiation and allogeneic bone marrow transplantation: long-term follow up of 79 females. Bone Marrow Transplant 1994; 14: 373–380.

    CAS  PubMed  Google Scholar 

  33. Peffault de Latour R, Levy V, Asselah T, Marcellin P, Scieux C, Adès L et al. Long-term outcome of hepatitis C infection after bone marrow transplantation. Blood 2004; 103: 1618–1624.

    Article  CAS  PubMed  Google Scholar 

  34. Strasser SI, Sullivan KM, Myerson D, Spurgeon CL, Storer B, Schoch HG et al. Cirrhosis of the liver in long-term marrow transplant survivors. Blood 1999; 93: 3259–3266.

    CAS  PubMed  Google Scholar 

  35. Strasser SI, Myerson D, Spurgeon CL, Sullivan KM, Storer B, Schoch HG et al. Hepatitis C virus infection and bone marrow transplantation: a cohort study with 10-year follow-up. Hepatology 1999; 29: 1893–1899.

    Article  CAS  PubMed  Google Scholar 

  36. Han CS, Miller W, Haake R, Weisdorf D . Varicella zoster infection after bone marrow transplantation: incidence, risk factors and complications. Bone Marrow Transplant 1994; 13: 277–283.

    CAS  PubMed  Google Scholar 

  37. Koc Y, Miller KB, Schenkein DP, Griffith J, Akhtar M, DesJardin J et al. Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. Biol Blood Marrow Transplant 2000; 6: 44–49.

    Article  CAS  PubMed  Google Scholar 

  38. Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ et al. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2006; 37: 249–261.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge the contribution of the medical and nursing staff of Leukemia/BMT Program of BC at Vancouver General Hospital and BC Cancer Agency, as well as the physicians of British Columbia for patient referral and assistance with long-term follow-up. We would like to thank Janet Nitta for data assistance, Alan Le for statistical support and Emily Gushe for help with manuscript preparation. This paper was presented in an abstract form at the 2006 BMT Tandem Meeting, Honolulu, Hawaii; 16–20 February 2006. The first author received an ASBMT young investigator award.

Author information

Authors and Affiliations

  1. Leukemia/Bone Marrow Transplant Program of British Columbia, British Columbia Cancer Agency, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Y R Abou-Mourad, M J Barnett, D L Forrest, D E Hogge, S H Nantel, T J Nevill, J D Shepherd, C A Smith, K W Song, H J Sutherland, C L Toze & J C Lavoie

  2. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Y R Abou-Mourad, B C Lau, M J Barnett, D L Forrest, D E Hogge, S H Nantel, T J Nevill, J D Shepherd, C A Smith, K W Song, H J Sutherland, C L Toze & J C Lavoie

Authors
  1. Y R Abou-Mourad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B C Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M J Barnett
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D L Forrest
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D E Hogge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S H Nantel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T J Nevill
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J D Shepherd
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C A Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. K W Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. H J Sutherland
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C L Toze
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J C Lavoie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y R Abou-Mourad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abou-Mourad, Y., Lau, B., Barnett, M. et al. Long-term outcome after allo-SCT: close follow-up on a large cohort treated with myeloablative regimens. Bone Marrow Transplant 45, 295–302 (2010). https://doi.org/10.1038/bmt.2009.128

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2009.128

Keywords

This article is cited by

Search

Advanced search

Quick links