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Introduction: Data on the incidence and causes of late (>100 d) non-relapse mortality (NRM) in autologous stem cell transplant (ASCT) recipients is limited. Patients and methods: We have analysed NRM in a cohort of 1482 adult patients who received ASCT in 1990–2003 in six Finnish transplant centres. The most common diagnoses included non-Hodgkin's lymphoma (NHL) ( n = 542), multiple myeloma (MM) ( n = 528), breast cancer ( n = 132); Hodgkin's lymphoma (HL) ( n = 86) and chronic lymphocytic leukaemia (CLL) ( n = 63). Results: Until September 2005, 646 patients (44%) have died. Late NRM was observed in 68 patients (4.6% of ASCT recipients; 11% of all deaths). There were 38 males and 30 females with a median age of 58 yr (20–69) at the time of ASCT. The median time to NRM was 27 months from ASCT (3–112). The risk of NRM was highest in patients with CLL (9.5%) and those with HL (8.1%) followed by MM and NHL (4.9% and 4.8%, respectively). The risk of late NRM was comparable in patients who received total body irradiation (TBI) and those who received chemotherapy-only regimens (6.7% vs. 4.3%). Another malignancy was the most common cause of late NRM (24 patients, 35% of late NRM). Twelve patients (0.8% of ASCT recipients) have died due to secondary haematological malignancy. Altogether 22 patients (32% of late NRM) died from infectious causes. Conclusions: Malignancies and late infections are important causes of NRM after ASCT. These facts point out the importance of prolonged follow-up in ASCT recipients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate early (<100 d) treatment-related mortality (TRM) in autologous stem cell transplant (ASCT) recipients. Patients: Altogether 1482 adult patients received ASCT in six Finnish centres 1990–2003. The most common diagnoses were non-Hodgkin's lymphoma (NHL) ( n = 542), multiple myeloma (MM) ( n = 528), breast cancer (BC) ( n = 132), Hodgkin's lymphoma ( n = 86) and chronic lymphocytic leukaemia (CLL) ( n = 63). Results: Forty-two patients (2.8%) died from treatment-related reasons <100 d from ASCT. The median time to death was 38 d from ASCT (0–99). The risk of TRM varied according to the diagnoses. The highest risk was observed in patients with AL amyloidosis (24%) followed by NHL (4.4%) and MM (1.9%). No early TRM was observed in patients transplanted for BC or CLL. Infections were the cause of death in 16 patients (fungal 7, bacterial 6, viral 3). Organ toxicity was responsible for early death in 26 patients (heart 9, lungs 7, other 10). Conclusions: This nation-wide survey indicated a low early TRM in ASCT recipients in general, but higher risks in patients with AL amyloidosis or NHL. In addition to patient selection, also optimization of transplant procedure may be needed in these patient groups to reduce early TRM. [ABSTRACT FROM AUTHOR]

Kuittinen T, Wiklund T, Remes K, Elonen E, Lehtinen T, Kuittinen O, Leppä S, Putkonen M, Räty R, Turpeenniemi-Hujanen T, Nousiainen T, Jantunen E. Outcome of progressive disease after autologous stem cell transplantation in patients with non-Hodgkin's lymphoma: a nation-wide survey. Eur J Haematol 2005: 75: 199–205. © Blackwell Munksgaard 2005. Objectives: To analyse outcome and prognostic factors in non-Hodgkin's lymphoma (NHL) patients who progress after autologous stem cell transplantation (ASCT). Patients: Altogether 115 consecutive NHL patients transplanted in 1991–2000 were studied. Histology included diffuse large B cell ( n = 52), follicular ( n = 26), mantle cell ( n = 15), T cell ( n = 16) and other subtypes ( n = 6). The median time from ASCT to the progression was 7 months. Ninety-six patients (83%) received salvage treatment. Results: Twenty-four patients (25%) achieved complete remission and 30 (31%) partial remission. The median overall survival was 8 months (range 0–98+) and the projected 4-year survival 21%. In multivariate analysis factors predicting treatment response after the progression included the use of rituximab ( P = 0.036), histology other than diffuse large B cell ( P = 0.001) and International Prognostic Index ≤2 at progression ( P < 0.001). Normal lactate dehydrogenase (LDH) at progression ( P = 0.002), response to salvage treatment ( P < 0.001) and time from ASCT to progression ≥7 months ( P = 0.022) were predictors for overall survival. Conclusions: Although the prognosis of patients who progress after ASCT is generally poor, many patients will respond to current therapies, and some may experience prolonged survival. Normal LDH at time of disease progression and longer time to progression after ASCT were the most powerful predictors for a promising outcome. [ABSTRACT FROM AUTHOR]

Jantunen E, Salonen J, Juvonen E, Koivunen E, Siitonen T, Lehtinen T, Kuittinen O, Leppä S, Anttila V-J, Itälä M, Wiklund T, Remes K, Nousiainen T. Invasive fungal infections in autologous stem cell transplant recipients: a nation-wide study of 1188 transplanted patients. Eur J Haematol 2004: 73: 174–178. © Blackwell Munksgaard 2004. Based on small single-centre series, the risk of invasive fungal infections (IFI) has been considered small in autologous stem cell transplant (ASCT) recipients. Purpose: To analyse epidemiological and clinical features of (IFI) among ASCT recipients in Finland 1990–2001. Patients: During the study period, 1188 adult patients received high-dose therapy supported by ASCT in six centres. Altogether, 1112 patients (94%) received blood progenitor cells. The graft was CD34+ selected in 261 patients (22%). The major diagnostic groups were non-Hodgkin's lymphoma ( n = 417), multiple myeloma ( n = 395), breast cancer ( n = 132) and Hodgkin's lymphoma ( n = 53). Results: Eighteen patients (1.5%) with IFI were identified. The incidence of proven or probable invasive aspergillosis was 0.8%, followed by candidaemia with an incidence of 0.3%. The median time to the diagnosis of IFI was 35 d (6–162) from the progenitor cell infusion. In fourteen patients (78%) IFI was diagnosed during lifetime and they were treated with antifungal therapy for a median of 50 d. Nine patients (64%) were cured. Conclusions: IFI appears to be a rare event after ASCT and Aspergillus infections seem to be predominant. These epidemiological features have an impact in planning prophylactic and empirical antifungal strategies in ASCT recipients. [ABSTRACT FROM AUTHOR]