title: Burden of morbidity in 10+ year survivors of hematopoietic cell transplantation: report from the bone marrow transplantation survivor study.
abstract: Long-term morbidity after hematopoietic cell transplantation (HCT) is unknown. The risk of physical and psychological health in 324 patients who had survived 10 or more years after HCT and a sibling comparison group (n = 309) was evaluated. Using the Common Terminology Criteria for Adverse Events, the 15-year cumulative incidence of severe/life-threatening/fatal conditions was 41% (95% confidence interval, 34% to 48%). HCT survivors were 5.7 times as likely to develop a severe/life-threatening condition (P < .001) and 2.7 times as likely to report somatic distress (P < .001) compared with siblings. Compared with allogeneic HCT recipients with no chronic graft-versus-host disease (GVHD), those with active chronic GVHD were at a 1.8-fold higher risk of severe/life-threatening health conditions (P = .006) and a 4.5-fold higher risk of somatic distress (P = .04); allogeneic HCT recipients with resolved chronic GVHD were not at increased risk of morbidity compared with those with no chronic GVHD. Only 27% of the HCT survivors returned to the transplantation center for their cancer-related care. The burden of long-term physical and emotional morbidity borne by survivors remains substantial, even beyond 10 years after HCT; however, specialized health care is underused. Patients, families, and healthcare providers need to be made aware of the high burden, so they can plan for post-HCT care, even many years after HCT.
authors.affiliation: Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA.
authors.forename: Can-Lan
authors.initials: CL
authors.lastname: Sun
authors.forename: John H
authors.initials: JH
authors.lastname: Kersey
authors.forename: Liton
authors.initials: L
authors.lastname: Francisco
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Forman
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D035781:Siblings; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents