Morbidity of Hematopoietic Transplant

Although hematopoietic cell transplant (HCT) is curative for some patients with hematologic malignancies, a recent study found substantial long-term physical and psychological morbidity, as well as increased risk of dying among HCT survivors. The study suggests that patients slated to undergo HCT should be aware of the potential long-term health risks associated with transplant and should be monitored accordingly. The study was presented at the 53rd Annual Meeting of the American Society of Hematology.

 

HCT survivors of ≥10 years had a higher risk of chronic illness, including cardiovascular disease, diabetes, and second cancers as well as somatic illness compared with age- and sex-matched siblings. Long-term survivors had nearly a 6 times higher risk than their matched siblings of developing severe or life-threatening illness. 

 

“Patients, families, and healthcare providers need to be aware of the high burden [of HCT], so that they can plan for post-HCT care, even many years after HCT,” said lead author Can-Lan Sun, PhD, associate research professor at City of Hope in Duarte, California.

 

Most long-term health problems of HCT are related to conditioning regimens (ie, high-dose chemotherapy and radiation) as well as potent immunosuppressive agents given to prevent rejection of the donor graft. Graft-vs-host disease and prolonged immune suppression can increase the risk of chronic disease and psychological problems.

 

The study population included 366 HCT survivors of ≥10 years and 309 matched siblings enrolled in the Bone Marrow Transplant Survivor Study. Primary diagnoses of survivors included acute myeloid leukemia (28%), chronic myelogenous leukemia (17%), acute lymphoblastic leukemia (17%), aplastic anemia (11%), Hodgkin lymphoma (7%), and “others” (10%).

 

At 15 years of follow-up, nearly 75% of survivors reported at least 1 chronic health condition versus 29% of siblings. About 25% of survivors reported severe or life-threatening conditions versus only 6% of siblings. Common illnesses among survivors included myocardial infarction, stroke, diabetes, subsequent cancers, and long-term somatic distress. For survivors, the 15-year cumulative incidence of any chronic health condition was 71%, and the incidence of severe or life-threatening illnesses and death was 40%. 

 

HCT survivors and their siblings had a similar prevalence of anxiety and depression, but survivors were more than 3 times as likely to report somatic distress attributed to psychological problems. Long-term survival of HCT was associated with high utilization of specialized health services. At 15 years following HCT, 61% of survivors reported a cancer- or HCT-related visit to a specialist.

 

Commenting on this study, transplant specialist Stephanie J. Lee, MD, professor at the University of Washington Fred Hutchinson Cancer Center in Seattle, said: “It’s great that we now have many more survivors, but this study shows us that when it’s over, it’s not really over.… As a society, we need to realize that HCT patients need long-term monitoring and care.”