Late altered organ function in very long-term survivors after allogeneic hematopoietic stem cell transplantation: a paired comparison with their HLA-identical sibling donor.
BACKGROUND
Hematopoietic stem cell transplantation has become an established procedure worldwide. Severe early and late complications are well described. Little is known about more subtle changes in general health status of very long-term survivors. The study objective was to assess health status of very long-term survivors in comparison with their respective human leukocyte antigen-identical sibling donors.


METHODS
Case matched comparison in a cross-sectional cohort was performed in a tertiary university hospital and referral center for hematopoietic stem cell transplantation. Forty-four pairs of recipients and their respective donors with a very long-term (17.5 years median; 11-26 years range) follow up after allogeneic hematopoietic stem cell transplantation were included. A comparative clinical evaluation and examination of routine clinical chemistry tests was carried out.


RESULTS
Recipients more frequently had a lower Karnofsky score (P = 0.05), hypertension (P = 0.015) and dyslipidemia (P = 0.002) but were less likely to be smokers (P = 0.016). Recipients showed systematically lower glomerular filtration rates (P < 0.0001), higher liver function tests (P = 0.0004 for Aspartat-Amino-Transferase) and reduced thyroid function (P = 0.002) despite normal or near normal values, and independent of presence or absence of chronic graft-versus-host disease. Indicators of inflammation were more frequent in recipients (9 of 44) with ongoing chronic graft-versus-host disease as measured by higher C-reactive protein (P = 0.001) and higher von Willebrand factor (P = 0.002). Conclusions Clinically very long-term survivors after an allogeneic hematopoietic stem cell transplantation present more frequently with cardiovascular risk factors and with subtle signs of altered organ function compared to their sibling donors. Even minimal ongoing chronic graft-versus-host disease remains associated with elevated laboratory indicators of inflammation. The clinical significance of these findings needs to be defined.
Rovó
Alicia
A
Department of Hematology, University Hospital of Basel, Basel, Switzerland. ARovo@uhbs.ch
Daikeler
Thomas
T
Halter
Jörg
J
Heim
Dominik
D
Tsakiris
Dimitrios A
DA
Stern
Martin
M
Waltimo
Tuomas
T
Studt
Jan Dirk
JD
Tyndall
Alan
A
Gratwohl
Alois
A
Tichelli
André
A
D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D006680:HLA Antigens / Q000378:metabolism; D019337:Hematologic Neoplasms / Q000503:physiopathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate; D017741:Survivors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens; D002097:C-Reactive Protein