1. ¹Department of Biomedical Sciences, Faculty of Applied Sciences, University of the West of England, Bristol, UK
2. ²Service d' Hematologie, Hopitaux Universitaires, Geneve, Switzerland
3. ³Department of Hematology, University Hospital, Basel, Switzerland
4. ⁴Department of Hematology and BMT, Ospedale S Camillo-Forlanini, Rome, Italy
5. ⁵Department of Haematology, Imperial College, Hammersmith Hospital, London, UK
6. ⁶Department of Hematology, Ospedale San Martino, Genova, Italy
7. ⁷BMT Unit, Department of Hematology, Rigshospitalet, Copenhagen, Denmark
8. ⁸Hematology Center, Karolinska University, Huddinge, Sweden
9. ⁹Department of Paediatric Oncology/BMT, Bristol Royal Hospital for Children, Bristol, UK
10. ¹⁰Ann Nunn: Avon Haematology Unit, Bristol Haematology and Oncology Centre, Bristol, UK
11. ¹¹Department of Orthopaedics, Southmead Hospital, Bristol, UK
12. ¹²Department of Hematology, Hopital St Louis, Paris, France

Correspondence: Dr JM Hows, Faculty of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK. E-mail: jill.hows@bristol.ac.uk

Received 18 April 2006; Revised 17 August 2006; Accepted 19 September 2006; Published online 30 October 2006.

Abstract

Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 775% for the MSD and 6711% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.