Although hematopoietic cell transplantation (HCT) cures many blood diseases, two-thirds of long-term survivors report at least one chronic health condition after the procedure, according to City of Hope researchers and colleagues.
The long-term study of more than 1,000 HCT patients appeared online in Blood on Aug. 18. Smita Bhatia, M.D., M.P.H., Ruth Ziegler Chair in Population Sciences and director of the Center for Cancer Survivorship, was the paper’s senior author. It is the first study to assess long-term health problems in a large group of HCT survivors.
|Smita Bhatia, left, and Canlan Sun (Photo by p.cunningham)|
“Although hematopoietic cell transplants have helped thousands of patients survive cancer, the burden of chronic illnesses borne by these survivors is substantial,” Bhatia said. “We hope the results of this study build awareness of the problem to help ensure a continued high quality of life among transplant survivors through lifelong follow-up and proactive care.”
Tens of thousands of patients every year undergo HCT to combat life-threatening diseases such as leukemia, lymphoma and aplastic anemia. The procedure transplants healthy blood-forming cells into a patient to replace cells destroyed by high-dose chemotherapy and radiation.
Although previous studies have shown that more than 70 percent of those who survive the first two years after HCT are expected to become long-term survivors, many experience long-lasting effects of treatment.
For their latest study, Bhatia and her colleagues examined the prevalence and severity of chronic health conditions reported by 1,022 HCT patients who received transplants between 1974 and 1998 at City of Hope or the University of Minnesota for a blood cancer or severe aplastic anemia. They then compared results to those of 309 brothers and sisters of the study participants.
The results showed that chronic health conditions were widespread in the HCT survivors. Among these patients, 66 percent reported at least one chronic condition, half reported at least two chronic health conditions, and 35 percent reported three or more conditions.
In comparison, 39 percent of the siblings reported at least one chronic health condition, but only 15 percent had two or more conditions, and 6 percent had three or more.
HCT patients also were more likely to have severe conditions such as cardiovascular, gastrointestinal and musculoskeletal problems or new malignancies. About 18 percent of HCT patients reported these severe conditions, compared to only 8 percent of the sibling group.
Additionally, 53 percent of the HCT survivors who had received grafts from a donor experienced chronic graft-versus-host disease (GVHD), a complication in which the foreign transplanted cells attack the cells in the recipient’s body. Although GVHD is treatable, this complication contributed significantly to the increased risk of severe or life-threatening conditions in these patients. Among the survivors with GVHD, nearly one-quarter had severe or life-threatening conditions such as cardiovascular and gastrointestinal disorders, and more than half had two or more health conditions.
Bhatia and her colleagues recommended that health-care providers conduct systematic and targeted follow-up of these high-risk patients.
City of Hope’s Canlan Sun, M.D., Ph.D., of the Department of Population Sciences was lead author on the paper. Colleagues included researchers from the University of Minnesota and St. Jude Children’s Research Hospital in Tennessee. The study was supported through grants from the National Institutes of Health and The Leukemia & Lymphoma Society.