Ted A. Gooley, Ph.D iodine ., Jason W. Chien, M.D., Steven A. Pergam, M.D., M.P.H., Sangeeta Hingorani, M.D., M.P.H., Mohamed L. Sorror, M.D., Michael Boeckh, M.D., Paul J. Martin, M.D., Brenda M. Sandmaier, M.D., Kieren A. Marr, M.D., Frederick R. Appelbaum, M.D., Rainer Storb, M.D., and George B. McDonald, M.D.: Reduced Mortality after Allogeneic Hematopoietic-Cell Transplantation Infections, graft-versus-web host disease , and liver, kidney, and pulmonary complications have been associated with large mortality after allogeneic hematopoietic-cell transplantation since the introduction of the procedure 40 years back.1 Changes in practice have decreased organ toxicity,2-5 and improved treatment and prevention strategies have decreased the severe nature of acute GVHD.6-9 The control of infectious complications has improved since the development of molecular methods for the detection of viral and fungal infections, the usage of preemptive treatments, the introduction of brand-new antifungal agents, and the prevention of nosocomial infection.10-13 To examine the hypothesis that adjustments in the treatment of patients undergoing transplantation have improved outcomes, we compared the rates of death not preceded by relapse, recurrent malignant conditions, and overall deaths in two large cohorts of our patients from 1993 through 1997 and from 2003 through 2007.
Although the features of the two groups differed just modestly, the combined group with persistently severe disability included a large proportion of subjects with advanced dementia. These results are consistent with those of previous studies, which have shown a higher burden of disability at the ultimate end of life among older persons with advanced dementia.19 As opposed to decedents with advanced dementia, a big minority of participants who died from cancer were not disabled over the last year of life. These results belie the idea that cancer by the end of life invariably results in disability and practical decline.13,20 We also discovered that the preceding course of disability varied considerably among the subjects with cancer who have been disabled during death; only about 40 percent of these subjects had a classic terminal phase seen as a an abrupt onset of disability within the last few months of life .21 Other investigators have postulated and provided supporting evidence that disability at the end of lifestyle follows specific but predictable trajectories for cancer, organ failing, and frailty.13 These findings were based on data collected at annual intervals, and disability ratings were averaged across all decedents with a particular condition leading to death.