Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors: Bone Marrow Transplantation

J. Styczyński, G. Tridello, L. Koster, S. Iacobelli, A. van Biezen, S. van der Werf, M. Mikulska, L. Gil, C. Cordonnier, P. Ljungman, D. Averbuch, S. Cesaro, R. de la Camara, H. Baldomero, P. Bader, G. Basak, C. Bonini, R. Duarte, C. Dufour, J. KuballA. Lankester, S. Montoto, A. Nagler, J.A. Snowden, N. Kröger, M. Mohty, A. Gratwohl, for the Infectious Diseases Working Party EBMT

Research output: Contribution to journalArticlepeer-review

Abstract

Information on incidence, and factors associated with mortality is a prerequisite to improve outcome after hematopoietic stem cell transplantation (HSCT). Therefore, 55′668 deaths in 114′491 patients with HSCT (83.7% allogeneic) for leukemia were investigated in a landmark analysis for causes of death at day 30 (very early), day 100 (early), at 1 year (intermediate) and at 5 years (late). Mortality from all causes decreased from cohort 1 (1980–2001) to cohort 2 (2002–2015) in all post-transplant phases after autologous HSCT. After allogeneic HSCT, mortality from infections, GVHD, and toxicity decreased up to 1 year, increased at 5 years; deaths from relapse increased in all post-transplant phases. Infections of unknown origin were the main cause of infectious deaths. Lethal bacterial and fungal infections decreased from cohort 1 to cohort 2, not unknown or mixed infections. Infectious deaths were associated with patient-, disease-, donor type, stem cell source, center, and country- related factors. Their impact varied over the post-transplant phases. Transplant centres have successfully managed to reduce death after HSCT in the early and intermediate post-transplant phases, and have identified risk factors. Late post-transplant care could be improved by focus on groups at risk and better identification of infections of “unknown origin”. © 2019, The Author(s).
Original languageEnglish
Pages (from-to)126-136
Number of pages11
JournalBone Marrow Transplant.
Volume55
Issue number1
DOIs
Publication statusPublished - 2020

Keywords

  • adolescent
  • adult
  • aged
  • allogeneic hematopoietic stem cell transplantation
  • Article
  • autologous hematopoietic stem cell transplantation
  • bacterial infection
  • cancer recurrence
  • cause of death
  • child
  • cohort analysis
  • controlled study
  • female
  • graft versus host reaction
  • human
  • idiopathic disease
  • infant
  • infection complication
  • leukemia
  • major clinical study
  • male
  • mixed infection
  • mortality
  • mycosis
  • observational study
  • postoperative period
  • priority journal
  • retrospective study
  • risk factor
  • time factor

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