Special Report
Bone Marrow Transplantation (2005) 36, 757–769. doi:10.1038/sj.bmt.1705140; published online 5 September 2005
Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time
A Gratwohl1, R Brand2, F Frassoni3, V Rocha4, D Niederwieser5, P Reusser6, H Einsele7 and C Cordonnier8 for the Acute and Chronic Leukemia Working Parties and the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation (EBMT)
- 1Division of Hematology, University Hospitals, Basel, Switzerland
- 2EBMT Support Office, Department of Medical Statistics, University of Leiden, Netherlands
- 3Department of Hematology, Ospedale San Martino, Genova, Italy
- 4Department of Hematology, BMT Unit, Hôpital St Louis, Paris, France
- 5Department of Haematology/Oncology, University of Leipzig, Germany
- 6Division of Medicine, Hôpital du Jura, Porrentruy, Switzerland
- 7Klinikum der Bayerischen Julius-Maximilian Universität, Würzburg, Germany
- 8Service d'Hématologie, Hôpital Henri Mondor, Créteil, France
Correspondence: Dr A Gratwohl, Division of Hematology, Department of Internal Medicine, University Hospital Basel, CH-4031 Basel, Switzerland. E-mail: hematology@uhbs.ch
Received 2 March 2005; Accepted 16 July 2005; Published online 5 September 2005.
Abstract
We analysed a large homogeneous group of 14 403 patients transplanted for early leukaemia from an HLA-identical sibling and reported to the EBMT in four time cohorts: 1980–1989 (24%), 1990–1994 (26%), 1995–1998 (30%) and 1999–2001 (20%). We focused on death from infection. End points were survival, death from relapse and transplant-related mortality (TRM), which was subdivided into death from graft-versus-host disease (GvHD) (1315 patients; 25% of deaths), infection (597 patients; 11% of deaths) or 'other' causes (1875 patients; 34% of deaths). Survival increased from 52% at 5 years in the first to 62% in the third cohort (P<0.05) and TRM decreased from 36 to 26% (P<0.05) due to a reduction in death from infection (P<0.001). GvHD, 'other' causes and relapse did not improve. The relative proportions of bacteria (217 patients; 36%), viruses (183 patients; 31%), fungi (166 patients; 28%) or parasites (32 patients; 5%) as cause of infectious death (cumulative incidence of death at 5 years 1.8, 1.6, 1.4 and 
0.3%, respectively) and median time to death from infections (3 months (range 0–158 months)) did not change. Death from infections has been reduced significantly, but it still represents an ongoing risk after HSCT and draws attention to the time beyond the initial period of neutropenia.
Keywords:
haematopoietic stem cell transplant, infections, cause of death, transplant-related mortality, change over time
