Long-Term Survivors of Hematopoietic Stem-Cell Transplant Pose Significant Burden to Healthcare System

March 2012, Vol 3, No 2

San Diego, CA—Survivors of hematopoietic cell transplant (HCT) have substantial medical illnesses and psychological symptoms ≥10 years after the procedure, representing a substantial burden to our healthcare system. Long-term HCT survivors have nearly a 6-fold greater risk than their siblings of life-threatening or severe illness or death, according to a study presented at ASH 2011. "Patients, families, and healthcare providers need to be aware of the high burden [of HCT] so they can plan for post-HCT care, even many years after HCT," said lead author Can-Lan Sun, MD, PhD, Associate Research Professor, City of Hope National Medi cal Center, Duarte, CA. HCT is often the only curative option for patients with hematologic malignancies, but not much is known about the long-term burden of HCT. This study showed that compared with age- and sex-matched siblings, survivors of ≥10 years had a higher risk of somatic illness (generalized pain) as well as chronic illness that includes cardiovascular disease, diabetes, and second cancers. The investigators analyzed late medical effects and quality of life in 366 HCT survivors of ≥10 years and 309 matched siblings enrolled in the Bone Marrow Transplant Survivor Study. The survivors had a variety of primary diagnoses, including acute myelogenous leukemia (28%), chronic myelogenous leukemia (17%), acute lymphoblastic leukemia (17%), aplastic anemia (11%), Hodgkin lymphoma (7%), and other diagnoses (10%).

During a 15-year follow-up period, nearly 75% of survivors reported at least 1 chronic health condition versus 29% of siblings. Approximately 25% of survivors reported severe or lifethreatening 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%. After adjusting for age, sex, marital status, race/ethnicity, education, income, insurance status, health status, and chronic health conditions, the prevalence of anxiety and depression was similar for HCT survivors and their siblings, but survivors were >3 times as likely to report somatic distress. "This is very important research," said Stephanie J. Lee, MD, Professor of Medicine, University of Washington Fred Hutchinson Cancer Center, Seattle, WA, who was not involved in the study. "With improvements in transplant, the numbers of survivors are growing and they are living longer. It is great that we now have many more survivors, but this study shows us that when it is over, it is not really over." Dr Lee, a transplant expert herself, said that people who undergo HCT should be aware that they are at higher risk for subsequent morbidity and seek preventive care and survivorship care. "As a society, we need to realize that HCT patients need long-term monitoring and care," she stated.

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