Long-term survival and late deaths after allogeneic bone marrow transplantation

Background and Methods It is uncertain whether mortality rates among patien ts who have undergone bone marrow transplantation return to the level of th e mortality rates of the general population. We analyzed the characteristic s of 6691 patients listed in the International Bone Marrow Transplant Regis try. All the patients were free of their original disease two years after a llogeneic bone marrow transplantation. Mortality rates in this cohort were compared with those of an age-, sex-, and nationality-matched general popul ation. Cox proportional-hazards regression was used to identify risk factor s for death more than two years after transplantation (late death). Results Among patients who were free of disease two yea rs after transplant ation, the probability of living for five more years was 89 percent (95 per cent confidence interval, 88 to 90 percent). Among patients who underwent t ransplantation for aplastic anemia, the risk of death by the sixth year aft er transplantation did not differ significantly from that of a normal popul ation. Mortality remained significantly higher than normal throughout the s tudy among patients who underwent transplantation for acute lymphoblastic l eukemia or chronic myelogenous leukemia and through the ninth year among th ose who underwent transplantation for acute myelogenous leukemia. Recurrent leukemia was the chief cause of death among patients who received a transp lant 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-versu s-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 myeloge nous leukemia, or aplastic anemia and who are free of their original diseas e two years later, the disease is probably cured. However, for many years a fter transplantation, the mortality among these patients is higher than tha t in a normal population. (N Engl J Med 1999;341:14-21.) (C)1999, Massachus etts Medical Society.