SAN DIEGO – Long after the event, hematopoietic stem cell recipients still bear a heavier burden of physical and emotional problems than do their siblings, and greater use of specialized health care, according to investigators at the annual meeting of the American Society of Hematology.
In all, 74% of transplant survivors reported having a chronic health condition at least 10 years on, compared with 39% of age-matched siblings in the Bone Marrow Transplant Survivor Study.
Dr. Can-Lan Sun
"The difference was especially prominent for severe or life-threatening conditions: 25% of the survivors versus 8% of the siblings reported having a severe, life threatening condition," said Dr. Can-Lan Sun, director of survey research at City of Hope Medical Center in Duarte, Calif., on behalf of coauthors at a press briefing.
"Survivors were five times more likely to report a severe life-threatening condition than siblings," she added.
The cumulative incidence of chronic health conditions over 15 years of follow-up was 71%, and the cumulative incidence of severe, life-threatening events was 40%, the authors found.
"We have many more survivors than we used to, and we’re very thankful for that, but I think it’s important to realize that once a transplant is over, it’s not really over – and that there are some long-term effects either because of the transplant procedure, or because of the chemotherapy that the patient had to get to the transplant," commented Dr. Stephanie J. Lee, professor of medicine at the University of Washington, and a transplant specialist at the Fred Hutchinson Cancer Research Center, both in Seattle.
Dr. Lee moderated the briefing but was not involved in the study.
The authors conducted a retrospective study that surveyed 366 hematopoietic cell transplantation (HCT) survivors of at least 10 years’ duration and compared outcomes of chronic health conditions and psychological health with those of 309 aged-matched siblings. The severe and/or life-threatening conditions they considered included:
• Impaired hearing (loss not corrected by hearing aids).
• Legal blindness.
• Dialysis support.
• Gastrointestinal problems (surgery for intestinal obstruction, rectal or anal strictures, or cirrhosis.
• Cardiovascular disease (coronary artery disease, congestive heart failure, stroke).
• Joint replacement.
• Diabetes.
• Subsequent cancers.
The majority of survivors (65%) had received allogeneic transplants from a relative, 27% had autologous transplants, and 8% received HCT from unrelated donors. In all, 72% of patients had a conditioning regimen with total body irradiation and cyclophosphamide or etoposide, or both.
Dr. Stephanie J. Lee
Indications for transplant were acute myeloid leukemia (28%), chronic myeloid leukemia (17%), acute lymphocytic leukemia (17%), non-Hodgkin’s lymphoma (11%), Hodgkin’s lymphoma (7%), aplastic anemia, or others (10%).
In an analysis adjusted for age at questionnaire, sex, race/ethnicity, education level attained, income and insurance status, they found that the relative risk (RR) for survivors to have any grade 1-4 condition was 2.16. The RR for having a grade 1 or 2 condition was 2.24, and for having a grade 3 or 4 condition was 5.64 (P less than .001 for all comparisons).
In addition, an analysis of adverse psychological outcomes, adjusted for the same factors, showed that survivors had an RR for somatic distress (unexplained physical symptoms such as pain, fatigue, etc.) of 2.73 (P = .03).
"Among survivors, females, those with low income, and those with poor health status were more likely to report somatic distress," Dr. Sun said.
In contrast, there were no significant differences between survivors and siblings in risk for anxiety, depression, or global distress.
Survivors also reported high use of health care services, with 78% reporting receiving a general physical examination within the past 2 years, and nearly two-thirds reporting that they had returned to the cancer center for ongoing care.
"As HCT continues to be a curative option for a variety of hematological malignancies, the burden of long-term physical and emotional morbidity formed by HCT recipients who have survived at least 10 years is substantial," Dr. Sun concluded.
The study was supported by a National Institutes of Health grant and a Leukemia & Lymphoma Society Scholar award to Dr. Sun. Neither she nor Dr. Lee had reported conflicts of interest.