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Life expectancy and burden of late complications after reduced intensity conditioning allogeneic transplantation

Abstract

Reduced intensity conditionings (RIC) before after allogeneic hematopoietic stem cell transplantation (HSCT) allow older or unfit patients of being transplanted, but survival expectancy and burden of late complications are poorly described in this setting. All patients (N = 456) who were alive and relapse-free 2 years after HSCT following RIC were included. Cumulative incidences (CI), standardized incidence, or mortality, ratio (SIR or SMR), and competing risk models were used. The 10-year CIs of relapse and non-relapse mortality incidences were 13.9 and 13.4%, respectively. Seventy-eight patients died, late relapse being the most frequent cause of death leading to a SMR of 6.38 (95% CI, 5.1–8.0; p < 0.001). Among non-relapsing patients (n = 412), 30 died (SMR 4.38; 95% CI, 3.3–5.8: p < 0.001). A total of 37 patients developed 41 SM leading to a 10-year cumulative incidence of 12.9%, and a significant SIR relative to the general population (1.4). Finally, we found high CI of cardiovascular (CVC) and venous thromboembolic complications (VTE) (10-year CI; 15.1% and 11.7%, respectively). Older age was the only significant risk factor for CVC and VTE in multivariable analysis. In conclusion, with life expectancy rate of 70%, late survivors after RIC warrants long-term follow-up and active intervention on averting cardiovascular disease and screening cancers.

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Fig. 1: Cumulative incidence of relapse and non-relapse mortality.
Fig. 2: Observed vs. expected survival.
Fig. 3: Cumulative incidences of late effects.

Data availability

Data collected and analyzed in this article came from patient’s chart and from the PROMISE data base. If any reasonable inquiry occurs, please direct the request to the last author at: gerard.socie@aphp.fr.

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ASDG: conducted statistical analyzes the data and wrote the manuscript; AR & AC: collect data; DM, MR, FSDF, AX, CF, LA, ER, CH, MB; recruited and took care of the patients and contributed to writing the report. RPDL; participated in study design, and to data interpretation, and contributed to writing the report: GS; was responsible for designing the study, interpreting results, analyzing data, and writing manuscript. All authors provided feedback and approved the report.

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Correspondence to Gérard Socié.

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Del Galy, A.S., Rousseau, A., Capes, A. et al. Life expectancy and burden of late complications after reduced intensity conditioning allogeneic transplantation. Bone Marrow Transplant 57, 1365–1372 (2022). https://doi.org/10.1038/s41409-022-01715-5

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