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

TY - JOUR

T1 - Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors

AU - Styczyński, Jan

AU - Tridello, Gloria

AU - Koster, Linda

AU - Iacobelli, Simona

AU - van Biezen, Anja

AU - van der Werf, Steffie

AU - Mikulska, Małgorzata

AU - Gil, Lidia

AU - Cordonnier, Catherine

AU - Ljungman, Per

AU - Averbuch, Diana

AU - Cesaro, Simone

AU - de la Camara, Rafael

AU - Baldomero, Helen

AU - Bader, Peter

AU - Basak, Grzegorz

AU - Bonini, Chiara

AU - Duarte, Rafael

AU - Dufour, Carlo

AU - Kuball, Jurgen

AU - Lankester, Arjan

AU - Montoto, Silvia

AU - Nagler, Arnon

AU - Snowden, John A

AU - Kröger, Nicolaus

AU - Mohty, Mohamad

AU - Gratwohl, Alois

AU - Infectious Diseases Working Party EBMT

PY - 2020/1

Y1 - 2020/1

N2 - 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".

AB - 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".

U2 - 10.1038/s41409-019-0624-z

DO - 10.1038/s41409-019-0624-z

M3 - SCORING: Journal article

C2 - 31455899

VL - 55

SP - 126

EP - 136

JO - BONE MARROW TRANSPL

JF - BONE MARROW TRANSPL

SN - 0268-3369

IS - 1

ER -