Bhatia S, Dai C, Landier W, et al. - Findings demonstrate a reduction in late mortality among recipients of allogeneic blood or marrow transplantation (BMT) over the past 40 years; however, failure of restoration of life expectancy to expected rates was evident in comparison with the general US population. In this population, further attempts to mitigate disease recurrence, infections, subsequent neoplasms, cardiovascular disease, and pulmonary disease could be beneficial.

• A retrospective cohort study of 4,741 people who lived 2 or more years following allogeneic BMT (performed in 3 eras: 1974-1989, 1990-2004, and 2005-2014), to analyze trends in life expectancy and cause-specific late mortality post-allogeneic BMT over a 40-year period.

• For recurrence-related mortality, the cumulative incidence plateaued at 10 years, reaching 12.2% at 30 years from BMT, and the incidence of nonrecurrence-related mortality kept on rising and was 22.3% at 30 years.

• Relative to the general population, the relative mortality continued to be higher at 30 or more years post-BMT (standardized mortality ratio, 5.4), and there was a 20.8% decrease in life expectancy in the cohort (8.7 years of life lost).

• Compared with 1974-1989 (reference), decline was evident in the adjusted 10-year hazard ratio (HR) of all-cause death over the 3 eras (1990-2004: HR, 0.67; 2005-2014: HR, 0.52) as well as of years of life lost (1974-1989: 9.9 years [reference]; 1990-2004: 6.5 years; and 2005-2014: 4.2 years).

• The most pronounced late mortality reduction was noted in those who had transplantation at ages younger than 18 years (1990-2004: HR, 0.62; 2005-2014: HR, 0.30; reference: 1974-1989; P < .001 for trend) and in those who received bone marrow (1990-2004: HR, 0.70; 2005-2014: HR, 0.45; reference: 1974-1989; P < .001 for trend).