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High probability of follow-up termination among AYA survivors after allogeneic hematopoietic cell transplantation

Koichi Miyamura, Takuya Yamashita, Yoshiko Atsuta, Tatsuo Ichinohe, Koji Kato, Naoyuki Uchida, Takahiro Fukuda, Kazuteru Ohashi, Hiroyasu Ogawa, Tetsuya Eto, Masami Inoue, Satoshi Takahashi, Takehiko Mori, Heiwa Kanamori, Hiromasa Yabe, Asahito Hama, Shinichiro Okamoto and Yoshihiro Inamoto

Key Points

  • The cumulative incidence of follow-up termination is 28% at 10 years, increasing to 67% at 25 years after allogeneic HCT.

  • Follow-up termination at HCT centers is most often made by physicians based on the patient’s good physical condition.

Abstract

The need for long-term follow-up (LTFU) after allogeneic hematopoietic cell transplantation (HCT) has been increasingly recognized for managing late effects such as subsequent cancers and cardiovascular events. A substantial population, however, has already terminated LTFU at HCT centers. To better characterize follow-up termination, we analyzed the Japanese transplant registry database. The study cohort included 17 980 survivors beyond 2 years who underwent their first allogeneic HCT between 1974 and 2013. The median patient age at HCT was 34 years (range, 0-76 years). Follow-up at their HCT center was terminated in 4987 patients. The cumulative incidence of follow-up termination was 28% (95% confidence interval [CI], 27%-29%) at 10 years, increasing to 67% (95% CI, 65%-69%) at 25 years after HCT. Pediatric patients showed the lowest probability of follow-up termination for up to 16 years after HCT, whereas adolescent and young adult (AYA) patients showed the highest probability of follow-up termination throughout the period. Follow-up termination was most often made by physicians based on the patient’s good physical condition. Multivariate analysis identified 6 factors associated with follow-up termination: AYA patients, female patients, standard-risk malignancy or nonmalignant disease, unrelated bone marrow transplantation, HCT between 2000 and 2005, and absence of chronic graft-versus-host disease. These results suggest the need for education of both physicians and patients about the importance of LTFU, even in survivors with good physical condition. The decreased risk for follow-up termination after 2005 may suggest the increasing focus on LTFU in recent years.

  • Submitted September 13, 2018.
  • Accepted January 9, 2019.
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