Which Transplantation Patients Are Most Likely to be Lost to Follow-Up?

Follow-up of patients who underwent hematopoietic cell transplantation (HCT) is significantly important to monitor for complications and intervene if necessary. A study analyzed incidence and predictors of patients being lost to follow-up.

Researchers followed two-year adult and child survivors of first allogeneic (adults, n=10,367; children, n=3,865) and autologous (adults, n=7,291; children, n=467) HCT who were treated for malignant/non-malignant disorders between 2002 and 2013. Being lost to follow-up was defined as two consecutive missed follow-up reporting periods; the cumulative incidence was calculated.

In adult allogeneic HCT survivors, the 10-year cumulative incidence of being lost to follow-up was 13% (95% confidence interval [CI], 12-14); in adult allogeneic HCT survivors, the 10-year incidence was 15% (95%  CI, 14-16). In pediatric patients, the 10-year cumulative incidence of being lost to follow-up was 25% (95% CI, 24-27) in allogeneic HCT survivors and 24% (95% CI, 20-29) in autologous HCT survivors. The following factors were predictive of being lost to follow-up in adult allogeneic HCT survivors: younger age, non-malignant disease, public/no insurance (reference, private), residence farther from the transplantation center, and being unmarried. In adult autologous HCT survivors, predictive factors were older age and testicular/germ cell tumor (reference, non-Hodgkin lymphoma). In the pediatric groups, predictors of being lost to follow-up in allogeneic HCT survivors were older age, public/no insurance (reference, private), and non-malignant disease, and in autologous HCT survivors, the only predictor was older age.

“Follow-up focusing on minimizing attrition in high-risk groups is needed to ensure surveillance for late effects,” the researchers concluded.