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	Full Text PDF Editorial by Thomas, E. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods It is uncertain whether mortality rates among patients who have undergone bone marrow transplantation return to the level of the mortality rates of the general population. We analyzed the characteristics of 6691 patients listed in the International Bone Marrow Transplant Registry. All the patients were free of their original disease two years after allogeneic bone marrow transplantation. Mortality rates in this cohort were compared with those of an age-, sex-, and nationality-matched general population. Cox proportional-hazards regression was used to identify risk factors for death more than two years after transplantation (late death).

Results Among patients who were free of disease two years after transplantation, the probability of living for five more years was 89 percent (95 percent confidence interval, 88 to 90 percent). Among patients who underwent transplantation for aplastic anemia, the risk of death by the sixth year after transplantation did not differ significantly from that of a normal population. Mortality remained significantly higher than normal throughout the study among patients who underwent transplantation for acute lymphoblastic leukemia or chronic myelogenous leukemia and through the ninth year among those who underwent transplantation for acute myelogenous leukemia. Recurrent leukemia was the chief cause of death among patients who received a transplant for leukemia, whereas chronic graft-versus-host disease was the chief cause among those who received a transplant for aplastic anemia. Advanced, long-standing disease before transplantation and active chronic graft-versus-host disease were important risk factors for late death.

Conclusions In patients who receive an allogeneic bone marrow transplant as treatment for acute myelogenous or lymphoblastic leukemia, chronic myelogenous leukemia, or aplastic anemia and who are free of their original disease two years later, the disease is probably cured. However, for many years after transplantation, the mortality among these patients is higher than that in a normal population.

Source Information

From the Service d'Hématologie–Greffe de Moelle, Hôpital Saint Louis, Paris (G.S.); the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee (J.V.S., P.A.R., J.P.K.); the College of Medicine, University of Florida, Gainesville (J.R.W.); the Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis (D.W.); the Division of Transplantation Medicine, University of South Carolina, Columbia (P.J.H.-D.); the Department of Medicine, University of Ottawa, Ottawa, Ont., Canada (C.B.); the Service d'Hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France (J.-Y.C.); the Department of Medicine, Kantonsspital Basel, Basel, Switzerland (J.R.P.); the Department of Internal Medicine, University Hospital, Maastricht, the Netherlands (H.C.S.); and the Department of Hematology, Klinikum Grosshadern, Munich, Germany (H.-J.K.). Other authors were Christine Bender-Götze, M.D., Department of Hematology–Oncology, Kinderpoliklinik, University of Munich, Munich, Germany; Bruce M. Camitta, M.D., Department of Pediatrics, Medical College of Wisconsin, Milwaukee; Kamar Godder, M.D., Division of Transplantation Medicine, University of South Carolina, Columbia; Mary M. Horowitz, M.D., International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee; and Alan S. Wayne, M.D., Division of Pediatric Hematology–Oncology, University of Miami School of Medicine, Miami.

Address reprint requests to Dr. Mary M. Horowitz at the International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Rd., P.O. Box 26509, Milwaukee, WI 53226, or at marymh{at}mcw.edu.

Full Text of this Article

Related Letters:

Long-Term Survival after Bone Marrow Transplantation
Oki Y., Kami M., Muto Y., Lounici A., Salmi L. R., Socié G., Klein J. P., Horowitz M. M., The Late Effects Working Committee of the International Bone Marrow Transplant Registry
Extract | Full Text  
N Engl J Med 1999; 341:1394-1395, Oct 28, 1999. Correspondence

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