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

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".

SUBMITTER: Styczynski J

PROVIDER: S-EPMC6957465 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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

Styczyński Jan J Tridello Gloria G Koster Linda L Iacobelli Simona S van Biezen Anja A van der Werf Steffie S Mikulska Małgorzata M Gil Lidia L Cordonnier Catherine C Ljungman Per P Averbuch Diana D Cesaro Simone S de la Camara Rafael R Baldomero Helen H Bader Peter P Basak Grzegorz G Bonini Chiara C Duarte Rafael R Dufour Carlo C Kuball Jurgen J Lankester Arjan A Montoto Silvia S Nagler Arnon A Snowden John A JA Kröger Nicolaus N Mohty Mohamad M Gratwohl Alois A

Bone marrow transplantation 20190827 1

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 ...[more]

PMID: 31455899

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Project description:PurposeHematopoietic stem cell transplant (HSCT) recipients are at risk for cognitive decline. Cross-sectional studies show patients' complaints of cognitive decline do not correlate well with concurrently measured objective neuropsychological performance, but rather with emotional variables and health-related quality of life. This longitudinal study investigated whether patient self-report of cognitive status would be concordant with objectively measured neuropsychological performance after accounting for change from their own pre-transplant objective baseline.MethodsPre-HSCT and at 30 and 100 days post-HSCT, 46 patients underwent computerized neuropsychological testing (CogState) and completed surveys assessing patient-reported cognitive complaints, emotional symptoms (depression, anxiety), sleep quality, daytime sleepiness, and physical and functional well-being. Correlations were calculated between cognitive complaints and neuropsychological performance (at each time-point and across time-points), as well as all other patient-reported variables.ResultsPatient-reported cognitive complaints were largely independent of concurrently assessed objective neuropsychological performance. Uniquely, our longitudinal data demonstrated significant medium to large effect size associations between subjective cognitive complaints post-HSCT with objectively measured change from pre-HSCT in attention, visual learning, and working memory (p < .05-.01). Subjective cognitive complaints post-HSCT were also associated with depression, anxiety, daytime sleepiness and physical well-being (p < .05-.001).ConclusionsPatients appear better able to assess their cognitive functioning relative to their own baseline and changes across time rather than relative to community norms. Thus, patient complaints of cognitive compromise justify further in-depth neuropsychological, emotional, and functional assessment. Future research into relationships between cognitive complaints and neuropsychological performance should account for changes in performance over time.

Dataset Information

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

Publications

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

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