Stem cell transplantation linked to suicide risk
MedwireNews: The risk for suicidal and accidental death may be elevated in patients who undergo hematopoietic stem cell transplantation (HSCT), research suggests.
The study shows that the 10-year cumulative incidence of suicides and accidental deaths was 101.8 and 55.6 per 100,000 patients who underwent HSCT, respectively.
This gives a standardized mortality ratio and absolute excess risk of suicide of 2.12 and 10.91, respectively, compared with the general European population, with corresponding rates for accidental death of 1.23 and 2.54, report André Tichelli (University Hospital Basel, Switzerland) and co-authors.
"The transplant community and the health care providers should be informed about the possibility that a person after HSCT may be suicidal or be exposed to an accident," they suggest in Cancer.
The researchers performed a case-control analysis of 294,922 patients who received allogenic (n=108,951) or autologous (n=185,971) HSCT between 1980 and 2009, matching each suicide or accidental death to three controls within the cohort. The majority (96%) of patients were treated for hematologic malignancy.
The prevalence of graft versus host disease (GVHD) after allogenic HSCT was significantly higher in those who committed suicide than controls (64 vs 37%). Patients relapsing after autologous HSCT were also significantly more likely to die from suicide (37 vs 18%). Conditional regressional analysis gave odds ratios of 2.91 and 4.48, respectively.
There was also a significant increased risk for accidental death in patients who experienced relapse after autologous HSCT (28 vs 14% of controls) but this was not seen in patients who underwent allogenic HSCT.
" It is conceivable that in addition to chronic GVHD or relapse, other relevant risk factors such as deterioration of quality of life, adverse social issues, or specific physical and mental limitations could be responsible for the increased suicide or accidental death rate in patients treated with HSCT," Tichelli et al comment.
Recommending that future studies determine whether these influences could identify patients at risk, the researchers emphasize that "suicide and accidental death cannot be ignored in data analysis on transplant outcome."
"These deaths have to be classified as transplant-related or external cause of death," they conclude.
By Lynda Williams, Senior medwireNews Reporter