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Assessment of Late ...
Assessment of Late Mortality Risk after Allogeneic Blood or Marrow Transplantation Performed in Childhood
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- Holmqvist, Anna Sällfors (författare)
- Lund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Chen, Yanjun (författare)
- University of Alabama
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- Wu, Jessica (författare)
- University of Alabama
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- Battles, Kevin (författare)
- University of Alabama
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- Bhatia, Ravi (författare)
- University of Alabama
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- Francisco, Liton (författare)
- University of Alabama
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- Hageman, Lindsey (författare)
- University of Alabama
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- Kung, Michelle (författare)
- University of Alabama
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- Ness, Emily (författare)
- University of Alabama
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- Parman, Mariel (författare)
- University of Alabama
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- Salzman, Donna (författare)
- University of Alabama
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- Wadhwa, Aman (författare)
- University of Alabama
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- Winther, Jeanette Falck (författare)
- Aarhus University,Danish Cancer Society
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- Rosenthal, Joseph (författare)
- City of Hope National Medical Center
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- Forman, Stephen J. (författare)
- City of Hope National Medical Center
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- Weisdorf, Daniel J. (författare)
- University of Minnesota
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- Armenian, Saro H. (författare)
- City of Hope National Medical Center
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- Arora, Mukta (författare)
- University of Minnesota
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- Bhatia, Smita (författare)
- University of Alabama
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(creator_code:org_t)
- 2018-12-13
- 2018
- Engelska.
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Ingår i: JAMA Oncology. - : American Medical Association (AMA). - 2374-2437. ; 4:12
- Relaterad länk:
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http://dx.doi.org/10...
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https://jamanetwork....
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- Importance: Allogeneic blood or marrow transplantation (BMT) is a curative option for malignant and nonmalignant diseases of childhood. However, little is known about trends in cause-specific late mortality in this population during the past 3 decades. Objectives: To examine cause-specific late mortality among individuals who have lived 2 years or more after allogeneic BMT performed in childhood and whether rates of late mortality have changed over time. Design, Setting, and Participants: A retrospective cohort study was conducted of individuals who lived 2 years or more after undergoing allogeneic BMT performed in childhood between January 1, 1974, and December 31, 2010. The end of follow-up was December 31, 2016. Exposure: Allogeneic BMT performed in childhood. Main Outcomes and Measures: All-cause mortality, relapse-related mortality, and non-relapse-related mortality. Data on vital status and causes of death were collected using medical records, the National Death Index Plus Program, and Accurint databases. Results: Among 1388 individuals (559 females and 829 males) who lived 2 years or more after allogeneic BMT performed in childhood, the median age at transplantation was 14.6 years (range, 0-21 years). In this cohort, there was a total of 295 deaths, yielding an overall survival rate of 79.3% at 20 years after BMT. The leading causes of death were infection and/or chronic graft-vs-host disease (121 of 244 [49.6%]), primary disease (60 of 244 [24.6%]), and subsequent malignant neoplasms (45 of 244 [18.4%]). Overall, the cohort had a 14.4-fold increased risk for death (95% CI, 12.8-16.1) compared with the general population (292 deaths observed; 20.3 deaths expected). Relative mortality remained elevated at 25 years or more after BMT (standardized mortality ratio, 2.9; 95% CI, 2.0-4.1). The absolute excess risk for death from any cause was 12.0 per 1000 person-years (95% CI, 10.5-13.5). The cumulative incidence of non-relapse-related mortality exceeded that of relapse-related mortality throughout follow-up. The 10-year cumulative incidence of late mortality decreased over time (before 1990, 18.9%; 1990-1999, 12.8%; 2000-2010, 10.9%; P =.002); this decrease remained statistically significant after adjusting for demographic and clinical factors (referent group: <1990; 1990-1999: hazard ratio, 0.64; 95% CI, 0.47-0.89; P =.007; 2000-2010: hazard ratio, 0.49; 95% CI, 0.31-0.76; P =.002; P <.001 for trend). Conclusions and Relevance: Late mortality among children undergoing allogeneic BMT has decreased during the past 3 decades. However, these patients remain at an elevated risk of late mortality even 25 years or more after transplantation when compared with the general population, necessitating lifelong follow-up.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Hematologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Hematology (hsv//eng)
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Holmqvist, Anna ...
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Chen, Yanjun
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Wu, Jessica
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Battles, Kevin
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Bhatia, Ravi
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Francisco, Liton
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visa fler...
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Hageman, Lindsey
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Kung, Michelle
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Ness, Emily
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Parman, Mariel
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Salzman, Donna
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Wadhwa, Aman
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Winther, Jeanett ...
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Rosenthal, Josep ...
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Forman, Stephen ...
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Weisdorf, Daniel ...
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Armenian, Saro H ...
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Arora, Mukta
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Bhatia, Smita
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Cancer och onkol ...
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Hematologi
- Artiklar i publikationen
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JAMA Oncology
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Lunds universitet