Burden of Morbidity Reported for Long-term Survivors of Hematopoietic Cell Transplantation
Bone Marrow Transplant Survivor Study analysis suggests long-term survivors of HCT have high risk of chronic psychological, and physical health conditions
Smita Bhatia, MD, MPH
An analysis of data from the Bone Marrow Transplant Survivor Study (BMTSS) suggests that long-term survivors of hematopoietic cell transplantation (HCT) have a much higher risk of chronic psychological, and physical health conditions than was previously assumed.
At 15 years post-transplant, the cumulative incidence of any chronic health condition in survivors was 71%, while the incidence of severe or life-threatening conditions or death was 40%.
“Although we have observed these rather sobering realities for 15-year post-transplant survival,” said study coauthor, Smita Bhatia, MD, MPH, chair of the department of Population Sciences, City of Hope, Duarte, CA, “we need to remember that transplant continues to be life saving, and possibly the only curative option for a large number of our patients with hematologic malignancies.” The focus of the present analysis is to determine the scope of the price paid for these successes.
Previously, Bhatia’s group had shown that patients who had HCT and who had survived 2 or more years were at increased risk of developing a wide range of chronic physical health and psychological conditions. However, as Bhatia noted, there was a lack of information regarding the burden of morbidity for survivors of much longer term.
Using resources offered by the BMTSS, Bhatia and colleagues looked at the psychological and physical health status of 366 patients with >10 years post-transplant survival, and compared these data with survivor siblings. Severity scores ranging from grade 1 (mild) to 5 (death due to chronic health condition) were assigned to each health condition. The Brief Symptom Inventory instrument was used to describe adverse psychological health.
Results for the study cohort showed that the mean age was 22 years at the time of HCT, and 37 years of age for study participation. The mean length of follow-up time was 15 years.
Regarding survivor health, at least one chronic health condition was reported by 74% survivors of HCT, as compared to 29% of the survivor’s siblings (P<0.001). Further, 25% of the survivors reported a severe life-threatening condition, compared to only 8% of their siblings (P<0.001).
Stephanie J. Lee, MD, MPH
Considered on the whole, the analysis showed that survivors had a greater than 5-fold likelihood of developing a severe, potentially life-threatening condition as compared to their age-matched siblings. Incidence of morbidity did not differ by malignancy type.
The most commonly reported severe/life-threatening chronic health conditions included stroke, myocardial infarction, diabetes, musculoskeletal problems, and subsequent malignancies. Survivors also reported a far higher incidence of anxiety and depression than their siblings.
Commenting on the study, HCT transplant specialist, Stephanie Lee, MD, MPH, professor of medicine, University of Washington School of Medicine, Seattle, WA, emphasized the need for greater awareness of the potential confounders of long-term survival. “We have a lot more HCT survivors now than we used to,” she said. “We’re thankful for that of course, but it’s important to realize that once the transplant is over, it’s not really over.” Lee stressed the need for awareness on the part of healthcare providers, their patients, and even third-party payors, of the reality that long-term, aggressive follow-up will be essential in cutting the rates of serious morbidities in patients with HCT.
