Late treatment-related mortality versus competing causes of death after allogeneic transplantation for myelodysplastic syndromes and secondary acute myeloid leukemia

Leukemia. 2019 Mar;33(3):686-695. doi: 10.1038/s41375-018-0302-y. Epub 2018 Dec 20.


The causes and rates of late patient-mortality following alloHCT for myelodysplastic syndromes or secondary acute myeloid leukemia were studied, to assess the contribution of relapse-related, treatment-related, and population factors. Data from EBMT on 6434 adults, who received a first alloHCT from January 2000 to December 2012, were retrospectively studied using combined land-marking, relative-survival methods and multi-state modeling techniques. Median age at alloHCT increased from 49 to 58 years, and the number of patients aged ≥65 years at alloHCT increased from 5 to 17%. Overall survival probability was 53% at 2 years and 35% at 10 years post-alloHCT. Survival probability at 5 years from the 2-year landmark was 88% for patients <45-year old and 63% for patients ≥65-year old at alloHCT. Cumulative incidence of nonrelapse mortality (NRM) for patients <45-year old at transplant was 7% rising to 25% for patients aged ≥65. For older patients, 31% of NRM-deaths could be attributed to population mortality. Favorable post-alloHCT long-term survival was seen; however, excess mortality-risk for all age groups was shown compared to the general population. A substantial part of total NRM for older patients was attributable to population mortality, information which aids the balanced explanation of post-HCT risk and helps improve long-term care.

MeSH terms

  • Aged
  • Cause of Death
  • Disease-Free Survival
  • Female
  • Hematopoietic Stem Cell Transplantation / mortality
  • Humans
  • Incidence
  • Leukemia, Myeloid, Acute / mortality*
  • Male
  • Middle Aged
  • Myelodysplastic Syndromes / mortality*
  • Neoplasms, Second Primary / mortality*
  • Recurrence
  • Retrospective Studies
  • Transplantation Conditioning / mortality
  • Transplantation, Homologous / mortality*