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Burden of Long-Term Morbidity Borne by Survivors of Acute Myeloid Leukemia Treated With Blood or Marrow Transplantation
TAKE-HOME MESSAGE
- The authors present a fascinating 20-year look into the lives of patients after receiving allogeneic (85%) or autologous (15%) stem cell transplantation (SCT) for acute myeloid leukemia. A quarter of patients rated their health as poor compared with a matched sibling. Notably, 10 years post transplantation, approximately 60% of patients experienced grade 3 to 5 comorbidities, approximately 30% developed subsequent malignant neoplasm after 10 years, and 8% to 10% of patients reported the incidence of cataracts, joint replacements, venous thromboembolism, or diabetes. At the 12-year mark, the cause of mortality was not related to disease relapse. Patients with chronic graft-versus-host disease had a higher comorbidity burden.
- As patients live longer after receiving SCT, guidelines for survivors should focus on the early detection of and intervention for comorbidities.
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
Blood or marrow transplantation (BMT) is an integral part of consolidation and/or salvage therapy for patients with acute myeloid leukemia (AML). With the growing population of AML survivors, there is a need to understand the quality of their survival.
MATERIALS AND METHODS
This multisite study included 1,369 2-year survivors who underwent BMT for AML between 1974 and 2014 at age ≥ 21 years and 1,310 siblings. Using Common Terminology Criteria for Adverse Events, severe/life-threatening and fatal chronic health conditions were identified. Multivariable regression analysis was used to compare the risk of severe/life-threatening conditions and health status between survivors and siblings, and to identify risk factors for health conditions among BMT survivors.
RESULTS
The prevalence of severe/life-threatening conditions was 54.9% in BMT survivors compared with 28.5% in siblings (P < .001), yielding 3.8-fold higher odds of severe/life-threatening conditions (95% CI, 3.1 to 4.7) among the BMT survivors. The most prevalent conditions included subsequent neoplasms, diabetes, cataracts, venous thromboembolism, and joint replacement. Survivors were more likely to report poor general health (odds ratio [OR], 3.8; 95% CI, 2.8 to 5.1), activity limitation (OR, 3.7; 95% CI, 3.0 to 4.5), and functional impairment (OR, 2.9; 95% CI, 2.3 to 3.6). Among BMT recipients, the 20-year cumulative incidence of severe/life-threatening/fatal conditions was 68%. History of chronic graft-versus-host disease was associated with a higher risk of pulmonary disease (hazard ratio [HR], 3.1; 95% CI, 1.0 to 9.3), cataract (HR, 2.6; 95% CI, 1.4 to 3.8), and venous thromboembolism (HR, 2.3; 95% CI, 1.3 to 4.7). Relapse-related mortality (RRM) plateaued at 30%, whereas non-RRM increased to 50% at 30 years.
CONCLUSION
The burden of severe/life-threatening conditions is substantially higher in BMT recipients when compared with an unaffected comparison group, contributing to an increasing incidence of non-RRM over time. Chronic graft-versus-host disease was an important risk factor for severe/life-threatening/fatal conditions among BMT recipients, informing the need for close monitoring to anticipate and manage morbidity.
Additional Info
Burden of Long-Term Morbidity Borne by Survivors of Acute Myeloid Leukemia Treated With Blood or Marrow Transplantation: The Results of the BMT Survivor Study
J. Clin. Oncol 2022 Jun 22;[EPub Ahead of Print], SH Armenian, Y Chen, L Hageman, J Wu, W Landier, A Bosworth, L Francisco, E Schlichting, R Bhatia, D Salzman, FL Wong, DJ Weisdorf, SJ Forman, M Arora, S BhatiaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Armenian et al examined the long-term morbidity after allogeneic hematopoietic stem cell transplantation (HSCT) among survivors of acute myeloid leukemia. Allogeneic HSCT is a major treatment modality for patients with hematologic malignancies and severe nonmalignant blood and immune disorders. There is a risk of treatment-associated mortality during the first year related to the toxicity of the preparative regimen, graft failure, graft-vs-host disease, and infections associated with post-transplant immune deficiency. A common misperception is that long-term survivors return to similar health as their peers. The authors examined the events occurring 2 years post transplantation and documented that there is a continuing higher risk of severe/life-threatening conditions (54.9% in transplant survivors vs 28.5% in siblings; P < .001). The most prevalent conditions included subsequent neoplasms, diabetes, cataracts, venous thromboembolism, and joint replacement. Patients with chronic graft-versus-host disease had a high risk of pulmonary disease. About a quarter of survivors rated their health as poor, and half reported significant activity limitations. Approximately 30% of survivors developed a subsequent malignancy within 10 years. Non-relapse mortality reached 50% after 30 years. These data demonstrate the importance of comprehensive long-term follow-up programs and support required for HSCT recipients, including close monitoring for second malignancies.