People who have had a bone marrow transplant may be at
increased risk for suicides and accidental deaths, according to a new study
suggesting these patients may need extra attention to the mental and physical
after-effects of their battles with disease.
In a group of almost 300 000 European bone marrow transplant
recipients, researchers found that patients killed themselves at twice the
rates seen in the general European population, and slightly more died in
Dr David Porter, a marrow transplantation expert who was not
involved in the research, told Reuters Health the findings are "eye
opening," because suicides and accidental deaths aren't often talked about
in the transplant community."It's not something that transplant physicians
would immediately assume," said Porter, from the Abramson Cancer Center of
the University of Pennsylvania in Philadelphia.
Bone marrow transplants
Bone marrow transplantation is used to treat a number of
conditions, including leukemia and other cancers, sickle cell disease and
immune diseases. The procedure involves replacing dysfunctional blood cells
with healthy stem cells from the patient or a donor, in the hope they will
create new, healthy blood and immune cells. Past research has found that more
than 20% of patients have symptoms related to depression after their marrow
transplant, the new study's authors write in the journal Cancer.
Those same depression signs are risk factors for suicide in
the general population, which suggests transplant patients could also be at
risk for suicide, explains the team led by Dr Andr Tichelli at University
Hospital Basel in Switzerland.
In addition, the researchers say, patients may be physically
and mentally weaker than they were before the transplant, which could put them
at risk for accidents. For the new study, Tichelli and his colleagues used a
European database of 294 922 bone marrow transplant patients from 1980 to 2009.
Almost all had a blood cancer.
Patients who passed
away during study
Overall, 116 149 patients died during the study. Included in
those deaths are 189 suicides and 125 accidental deaths. The rest died from a
relapse of their disease or a transplant-related cause. The researchers found
there were about 21 suicides per 100 000 people who had a marrow transplant. That
compared to about nine per 100 000 people in the general population of Europe.
There are about 11 suicides per 100 000 people in the
general US population, according to the National Institute of Mental Health. Patients
whose disease relapsed were more likely to commit suicide - especially those
who acted as their own bone marrow donors.
Dr Fausto Loberiza Jr, who studies outcomes after bone
marrow transplants and wrote an editorial accompanying the study, said there
could be an increased risk of suicide because cancer patients are already at an
increased risk of depression."What we know is that cancer patients - in
general - have a higher incidence of depression.
We do know that there
is also high incidence of depression in (bone marrow) transplant
patients," said Loberiza, from the University of Nebraska Medical Center. That,
he said, also means there is a question of whether the transplants or the
cancers that create the need for a transplant are actually behind the increased
Car crashes recorded
Tichelli's group also found about 14 accidental deaths per
100 000 transplant patients, compared to about 11 per 100 000 people in the
general population. The biggest causes of accidental death were car crashes.
Tichelli told Reuters Health that most transplant doctors
wouldn't know transplant patients are at an increased risk of suicide or
accidental deaths, because those occurrences are rare. "A local study
would never show the difference, because the number of patients would be too
small," Tichelli said. He told Reuters Health the new findings show that
it's important for doctors to ask patients how they're feeling physically and
emotionally after their transplants - especially during the first few years.
He added that doctors should also discuss patients' physical
limitations to help reduce the risk of accidental deaths. For example, not
driving cars at night."Patients may or may not speak about it, but if we
ask they are probably happy that we approach the problem," Tichelli said.