Increased Morbidity and Mortality in HCT Survivors vs Other Cancer Survivors


Key Points

  • Hematopoietic cell transplantation survivors had greater morbidity and mortality vs non–hematopoietic cell transplantation survivors.
  • High rates of late respiratory and infectious complications were observed in hematopoietic cell transplantation survivors.

In a study reported in the Journal of Clinical Oncology, Chow et al found that hematopoietic cell transplantation survivors had higher rates of morbidity and mortality compared with a matched population of patients with cancer not undergoing hematopoietic cell transplantation.

The study involved 1,792 two-year hematopoietic cell transplantation survivors who were treated at a comprehensive cancer center in Washington State from 1992 through 2009; 52% received allogeneic hematopoietic cell transplantation, and 90% had hematologic malignancies. These patients were frequency matched for demographic characteristics and underlying cancer diagnosis with non–hematopoietic cell transplantation 2-year cancer survivors from the state cancer registry (n = 5,455).

Increased Risks

Median follow-up was 7.1 years. Hematopoietic cell transplantation survivors had a greater rate of hospitalization (280 vs 173 episodes/1,000 person-years, P < .001) and greater all-cause mortality (hazard ratio [HR] = 1.1, 95% confidence interval [CI] = 1.01–1.3) compared with matched non–hematopoietic cell transplantation cancer survivors.

Hematopoietic cell transplantation survivors had more hospitalizations or death with infections (10-year cumulative incidence = 31% vs 22, HR = 1.4, 95% CI = 1.3–1.6), respiratory complications (cumulative incidence = 27% vs 20%, HR = 1.4, 95% CI = 1.2–1.5), and skin (HR = 1.3, 95% CI = 1.0–1.6) and musculoskeletal complications (HR = 1.3, 95% CI = 1.1–1.5). Similar rates of circulatory complications and second cancers were observed for hematopoietic cell transplantation and non–hematopoietic cell transplantation survivors.

The investigators concluded: “History of [hematopoietic cell transplantation] was associated with late morbidity and mortality among cancer survivors. In particular, clinicians who care for [hematopoietic cell transplantation] survivors should be aware of their high rates of late respiratory and infectious complications.”

The study was supported by the National Institutes of Health and the National Cancer Institute.

Eric J. Chow, MD, MPH, of Fred Hutchinson Cancer Research Center, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.