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If you are alive and free of disease two years after a donor transplant, around nine in ten are alive five years later and 85 per cent at ten years. The death rate among transplant survivors stays higher than in people of the same age who never had one, for many years. The two things that matter most are age and chronic graft-versus-host disease.
Two large registry studies, eleven years apart, give the same answer with different numbers.
The International Bone Marrow Transplant Registry analysed 6,691 patients who were free of their original disease two years after allogeneic bone marrow transplantation and compared their mortality with an age, sex and nationality-matched general population. Among those disease-free at two years, the probability of living five more years was 89 per cent (95 per cent CI 88 to 90). For patients transplanted for aplastic anaemia, the risk of death by the sixth year after transplant did not differ significantly from a normal population. For acute lymphoblastic leukaemia and chronic myeloid leukaemia, mortality remained significantly higher than normal throughout the study; for acute myeloid leukaemia it remained higher through the ninth year. Recurrent leukaemia was the chief cause of death.
The CIBMTR repeated the exercise in a larger and later cohort: 10,632 patients worldwide who were alive and disease-free two years after a myeloablative allogeneic transplant performed before 2004 for acute myeloid or lymphoblastic leukaemia, myelodysplastic syndrome, lymphoma or severe aplastic anaemia. Median follow-up was nine years and 3,788 patients had been observed for ten years or more. The probability of being alive ten years after transplant was 85 per cent. The chief risk factors for late death were older age and chronic graft-versus-host disease. For those transplanted for a malignancy, relapse was the commonest cause of death, and the greatest risk factor for late relapse was advanced disease at transplantation. The principal risk factors for non-relapse death were older age and GvHD. Compared with an age, sex and nationality-matched general population, late deaths remained higher than expected for each disease, with the possible exception of lymphoma.
Two honest qualifications belong next to those numbers. First, both cohorts are conditional on surviving two years disease-free, so they describe the outlook from that point and not from the day of transplant. Second, both describe transplants performed with the conditioning, supportive care and donor matching of their era; the CIBMTR cohort is of transplants before 2004. Supportive care, prophylaxis and donor selection have changed since, and the direction of change in non-relapse mortality has been downwards, so a person transplanted today is not described exactly by either curve.
What does not change is the shape of the finding, and it is the frame for every other record in this file. Mortality after a successful transplant falls steeply and then flattens at a level above the background rate, and the gap is made of relapse, second cancers, infection, lung disease and chronic GvHD. Every one of those has a surveillance or prevention step attached to it. The curve is the argument for long-term follow-up, not a verdict about any individual.
Late mortality after transplant is the sum of a declining hazard, relapse of the original disease, and a slowly rising hazard, the late effects of conditioning and of chronic alloimmunity. Because the second component rises with time while the first falls, total excess mortality flattens rather than reaching zero, and the longer a cohort is followed the more of the excess is non-relapse.
Query for this technology: (TITLE:"Survival after transplant, and why the curve never quite rejoins the population" OR ABSTRACT:"Survival after transplant, and why the curve never quite rejoins the population" OR TITLE:"late mortality after HSCT" OR ABSTRACT:"late mortality after HSCT" OR TITLE:"long-term survival after transplant" OR ABSTRACT:"long-term survival after transplant" OR TITLE:"excess mortality after transplant" OR ABSTRACT:"excess mortality after transplant") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Survival after transplant, and why the curve never quite rejoins the population, not a curated reading list.
Shares Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered, Late effects after a stem cell transplant, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation and the tags rejuvenation, survivorship, transplant, late-effects.
Shares Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered, Late effects after a stem cell transplant, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation and the tags rejuvenation, survivorship, transplant, late-effects.
Shares Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered, After a transplant or cell therapy: what to ask for, Secondary malignancy (therapy-related cancer), Late effects and survivorship toxicity and the tags rejuvenation, survivorship, transplant.
Shares Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered, Chronic graft-versus-host disease, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation and the tags rejuvenation, survivorship, transplant.
Shares Late effects after a stem cell transplant, Chronic graft-versus-host disease, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation and the tags rejuvenation, survivorship, transplant.
Shares Second cancers after allogeneic transplant, Chronic graft-versus-host disease, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation and the tags rejuvenation, survivorship, transplant.
Shares Late effects after a stem cell transplant, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship, transplant, late-effects.
Shares Late effects after a stem cell transplant, After a transplant or cell therapy: what to ask for, Allogeneic stem cell transplantation, Survivorship care and late-effects surveillance and the tags rejuvenation, survivorship, transplant, late-effects.