Subsequent neoplasms and late mortality in children undergoing allogeneic transplantation for nonmalignant diseases

Abstract We examined the risk of subsequent neoplasms (SNs) and late mortality in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases (NMDs). We included 6028 patients (median age, 6 years; interquartile range, 1-11; range, <1 to 20) from the Center for International Blood and Marrow Transplant Research (1995-2012) registry. Standardized mortality ratios (SMRs) in 2-year survivors and standardized incidence ratios (SIRs) were calculated to compare mortality and SN rates with expected rates in the general population. Median follow-up of survivors was 7.8 years. Diagnoses included severe aplastic anemia (SAA; 24%), Fanconi anemia (FA; 10%), other marrow failure (6%), hemoglobinopathy (15%), immunodeficiency (23%), and metabolic/leukodystrophy syndrome (22%). Ten-year survival was 93% (95% confidence interval [95% CI], 92% to 94%; SMR, 4.2; 95% CI, 3.7-4.8). Seventy-one patients developed SNs (1.2%). Incidence was highest in FA (5.5%), SAA (1.1%), and other marrow failure syndromes (1.7%); for other NMDs, incidence was <1%. Hematologic (27%), oropharyngeal (25%), and skin cancers (13%) were most common. Leukemia risk was highest in the first 5 years posttransplantation; oropharyngeal, skin, liver, and thyroid tumors primarily occurred after 5 years. Despite a low number of SNs, patients had an 11-fold increased SN risk (SIR, 11; 95% CI, 8.9-13.9) compared with the general population. We report excellent long-term survival and low SN incidence in an international cohort of children undergoing HCT for NMDs. The risk of SN development was highest in patients with FA and marrow failure syndromes, highlighting the need for long-term posttransplantation surveillance in this population.

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Long-Term Survival and Late Relapse in 5-Year Survivors of Allogeneic Hematopoietic-Cell Transplantation (HCT) for Chronic Myeloid Leukemia (CML) in First Chronic Phase.

Blood ◽

10.1182/blood.v114.22.3321.3321 ◽

2009 ◽

Vol 114 (22) ◽

pp. 3321-3321

Author(s):

John M. Goldman ◽

Navneet S. Majhail ◽

John P. Klein ◽

Zhiwei Wang ◽

Kathleen A. Sobocinski ◽

...

Keyword(s):

General Population ◽

Conflicts Of Interest ◽

Chronic Gvhd ◽

Chronic Phase ◽

Term Survival ◽

Long Term Survival ◽

Late Mortality ◽

Allogeneic Hct ◽

Risk Of Relapse

Abstract Abstract 3321 Poster Board III-209 Prior to the advent of tyrosine kinase inhibitors, allogeneic HCT was standard therapy for CML. However, very long-term outcomes of allogeneic HCT for CML are not well described. To evaluate the probability and risk factors for late mortality and relapse in this patient population, we conducted a retrospective cohort study that included 2444 patients who received a myeloablative allogeneic HCT for CML in first chronic phase between 1978 and 1998 and had survived in continuous complete remission for at least 5 years. Relapse was considered the earliest reported date of the following: hematologic recurrence, cytogenetic recurrence or initiation of therapy for recurrence. The median followup of our cohort was 11 years (range, 5-25) from HCT; 377 patients had followup >15 years. Donor sources were HLA-matched siblings (MSD) in 1692, unrelated donors (URD) in 639 and other related donors in 113 patients. The median age at HCT was 35 years and patients primarily received bone marrow grafts (96%) and conditioning using either total-body irradiation (TBI, 61%) or BuCy (38%) regimens. Acute and chronic graft-versus-host disease (GVHD) occurred in 43% and 62% of patients, respectively. The probabilities of overall survival at 15 years were 88% (95% CI, 86-90%) for MSD and 87% (83-90%) for URD recipients. Corresponding cumulative incidences of relapse at 15 years were 8% (7-10%) and 2% (1-4%), respectively. The latest reported relapse occurred 18 years post-HCT. In multivariable analyses addressing the importance of patient, disease and transplant related factors for long-term survival, older age at HCT, use of female donor for a male recipient, use of TBI based conditioning, acute GVHD and chronic GVHD all independently increased the risk of late mortality. Chronic GVHD reduced the risk of relapse, but increased the risk of non-relapse mortality. Recipients of MSD and URD had similar risks of long-term mortality, relapse and non-relapse mortality. Compared to an age, gender and race adjusted general population, 5 year survivors of HCT for CML were 2.9 times (95% CI, 1.9-3.9) more likely to die at 6 years and 2.5 times (1.3-3.7) more likely to die at 10 years after HCT. However, by 15 years after HCT, their relatively mortality (2.3 [0-4.9]) was not significantly different than the general population. In summary, recipients of allogeneic HCT for CML in first chronic phase who remain in remission for at least 5 years after HCT have very favorable subsequent long-term survival with mortality rates eventually approaching those of the general population. There is a small but continuing risk of relapse even in these long-term survivors. Chronic GVHD protects against relapse but increases the risks of non-relapse mortality. Disclosures No relevant conflicts of interest to declare.

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