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Epidemiology and Virology

Conditional survival and cause-specific mortality after autologous hematopoietic cell transplantation for hematological malignancies

Leukemia volume 27, pages 1139–1145 (2013)Cite this article

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Abstract

The probability of survival is conventionally calculated from autologous hematopoietic cell transplantation (aHCT). Conditional survival takes into account the changing probability of survival with time survived, but this is not known for aHCT populations. We determined disease- and cause-specific conditional survival for 2388 patients treated with aHCT over a period of 20 years at a single institution. A total of 1054 deaths (44% of the cohort) were observed: 78% attributed to recurrent disease; 9% to subsequent malignancies and 6% to cardiopulmonary disease. Estimated probability of relative survival was 62% at 5 years and 50% at 10 years from aHCT. On the other hand, the 5-year relative survival was 70, 75, 81 and 88% after having survived 1, 2, 5 and 10 years after aHCT, respectively. The cohort was at a 13.9-fold increased risk of death compared with the general population (95% confidence interval (CI)=13.1–14.8). The risk of death approached that of the general population for 10-year survivors (standardized mortality ratio (SMR)=1.4, 95% CI=0.9–1.9), with the exception of female Hodgkin’s lymphoma patients transplanted before 1995 at age ⩽40 years (SMR=6.0, 95% CI=1.9–14.0). Among those who had survived 10 years, nonrelapse-related mortality rates exceeded relapse-related mortality rates. This study provides clinically relevant survival estimates after aHCT, and helps inform interventional strategies.

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Acknowledgements

This study was supported in part by grants from the National Institute of Health (R01 CA078938 (to SB), P01 CA 30206 (to SJF) and the Leukemia Lymphoma Society (2192 (to SB)).

Author contributions

Ari M VanderWalde performed the research, analyzed and interpreted the data and wrote the manuscript. Can-Lan Sun analyzed and interpreted the data and wrote the manuscript. Lester Laddaran and Liton Francisco performed the research and interpreted the data. Saro Armenian, F Lennie Wong, Leslie Popplewell, George Somlo, Anthony S Stein, Auayporn Nademanee, Amrita Krishnan, Neil Kogut, Stephen J Forman provided critical insight in the interpretation of the data. Jennifer Berano-Teh performed the research and interpreted the data. Smita Bhatia procured funding, designed the study, supervised and performed the research, analyzed and interpreted the data and wrote the manuscript.

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Authors and Affiliations

  1. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    A M VanderWalde, L Popplewell, A S Stein, A Nademanee, A Krishnan, N Kogut, S J Forman & S Bhatia

  2. Department of Medical Oncology and Experimental Therapeutics, City of Hope, Duarte, CA, USA

    A M VanderWalde & G Somlo

  3. Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA

    C-L Sun, L Laddaran, L Francisco, S Armenian, J Berano-Teh, F L Wong & S Bhatia

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  1. A M VanderWalde
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  2. C-L Sun
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  10. A S Stein
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Corresponding author

Correspondence to S Bhatia.

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Supplementary Information accompanies the paper on the Leukemia website

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VanderWalde, A., Sun, CL., Laddaran, L. et al. Conditional survival and cause-specific mortality after autologous hematopoietic cell transplantation for hematological malignancies. Leukemia 27, 1139–1145 (2013). https://doi.org/10.1038/leu.2012.311

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