-
1.
Health-Related Quality of Life Outcomes in Older Hematopoietic Cell Transplant (HCT) Survivors
Hong, S., Zhao, J., Wang, S., Wang, H., Lee, J. H., Farhadfar, N., McGuirk, J. P., Savani, B. N., Shahrukh, H. K., Stiff, P., et al
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Hematopoietic cell transplantation (HCT) use for older patients has been increasing. Distress, psychosocial functioning, and health-related quality of life (HRQOL) among older HCT survivors is largely unknown. METHODS In this secondary analysis using data from two randomized controlled trials, we analyzed baseline cancer and treatment distress (CTXD) and confidence in survivorship information (CSI) surveys of survivors who were ≥60 years at transplant and alive and disease-free ≥1 year post-autologous or allogeneic HCT. We analyzed associations of these parameters with physical and mental component summary (PCS/MCS) scores of SF-12 and healthcare adherence (HCA) scale, after adjusting for transplant and demographic factors. RESULTS A total of 567 patients were included. Median age at HCT was 65 years, 68% received autologous HCT. Median CTXD score was mild at 0.7, and the highest distress was reported in the "Health Burden" subscale. Median CSI score was moderate-high at 1.4, with the lowest confidence reported in the "Late Effects" subscale. We found a negative Spearman correlation between CTXD and PCS (p= -0.59)/MCS (p= -0.54) and positive Spearman correlation between CSI and PCS (p= 0.23)/MCS (p= 0.30). Median HCA was high at 0.8. Male sex, autologous HCT, increased distress level, and worse CSI were associated with lower use of preventive care. CONCLUSION Older survivors experienced a low level of distress and moderate-high level of CSI at ≥1year post-HCT. As lower distress and higher CSI were associated with improved HRQOL and optimized preventive HCA, CTXD/CSI measures can be used to individualize the care of older adult HCT survivors.
-
2.
Health Related Quality of Life in Young Adults Survivors of Hematopoietic Cell Transplantation
Rotz, S. J., Yi, J. C., Hamilton, B. K., Wei, W., Preussler, J. M., Cerny, J., Deol, A., Jim, H., Khera, N., Hahn, T., et al
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Young adults, age 18-39, are at a stage of life which may make them more vulnerable than older adults to impairments in health-related quality of life (HRQOL) during and after hematopoietic cell transplantation (HCT). Health self-efficacy (HSE) is the belief that one can implement strategies to produce a desired health outcome and has been associated with health outcomes in oncology research. Little is known about HRQOL or HSE in young adult HCT survivors compared to older HCT survivors. OBJECTIVE Given the age-specific psychosocial challenges facing young adult HCT recipients and research on non-transplant young adult cancer survivors, we hypothesized that young adult survivors would have worse post-HCT HRQOL compared to older adults and that among young adult HCT survivors, higher levels of HSE would be associated with higher HRQOL and lower levels of cancer-related distress. STUDY DESIGN This is a cross-sectional secondary analysis of two combined baseline datasets from multi-center studies of HCT survivors approached for participation in clinical trials of survivorship interventions. Participants from 20 transplant centers in the US were 1-10 years post-HCT, ≥18 years of age at the time of study enrollment, had no evidence of disease relapse/progression or subsequent malignancies, and read English adequate to consent and complete assessments. Medical record and patient-reported data were obtained for demographics and HCT-related clinical factors and complications (e.g. total body irradiation, chronic graft-versus-host disease). Participants completed surveys on HRQOL (Short-form [SF]-12), HSE, and Cancer and Treatment Distress (CTXD), which includes six subscales and an overall mean score. SF-12 was calculated for both mental (MCS) and physical (PCS) component scores. Participants were compared between two cohorts: young adults (age 18 to 39 at transplant) and older adults (age ≥40 at transplant). Multiple linear regression analyses determined factors associated with HSE, PCS, MCS and CTXD within young adults. RESULTS In this analysis of N=979 survivors, compared to older adults, young adult participants had lower mental health scores (SF-12 MCS: 48.40 vs. 50.23, P=0.04) and higher cancer-related distress (CTXD: 0.96 vs. 0.85, P=0.04), though better physical health (SF-12 PCS: 48.99 vs. 47.18, P=0.049). Greater overall cancer-related distress was driven by higher levels of uncertainty, financial concern, and medical demand subscales for young adults compared with older adults. Young adults also had lower HSE (2.93 vs. 3.08, P=0.0004). In a multivariate model, HSE was strongly associated with age group (p=0.0005) after adjusting for multiple other transplant related factors. Among young adults, HSE was associated with mental and physical components of the SF-12 and the CTXD, and HSE remained significant after adjusting for other transplant-related factors. CONCLUSIONS Overall, young adult HCT survivors have lower mental health, increased cancer-related distress, and lower levels of HSE compared to older adults. Although the direction of these effects cannot be determined with these data, the strong association between HSE and HRQOL among young adults suggests that targeting interventions to improve HSE may have broad impact on health outcomes.
-
3.
Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation
Phelan, R., Im, A., Hunter, R. L., Inamoto, Y., Lupo-Stanghellini, M. T., Rovo, A., Badawy, S. M., Burns, L., Eissa, H., Murthy, H. S., et al
Bone marrow transplantation. 2022
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
-
4.
Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States
Bhatt, N. S., Brazauskas, R., Salit, R. B., Syrjala, K., Bo-Subait, S., Tecca, H., Badawy, S. M., Baker, K. S., Beitinjaneh, A., Bejanyan, N., et al
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Young adult (YA) survivors of allogeneic hematopoietic cell transplant (HCT) are at risk for late psychosocial challenges, including inability to return to work post-HCT. However, work-related outcomes in this population remain understudied. OBJECTIVES To assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YA and analyze the patient-, disease-, and HCT-related factors associated with their work status at 1-year post-HCT. STUDY DESIGN Using the Center for International Blood and Marrow Transplant Research (CIBMTR) data, we described post-HCT work status (full-time, part-time work, unemployed, and medical disability) of YA HCT survivors (N=1365) who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at four timepoints: 6-months, 1-, 2-, and 3-year post-HCT. Percentages of post-HCT work status categories at the 1-year timepoint were also described in relation to survivors' pre-HCT work status categories. Factors associated with 1-year post-HCT work status (full-time or part-time work) were examined using logistic regression. RESULTS From 6 months to 3 years post-HCT, the percentage of survivors working full-time and part-time increased from 18.3% to 50.7%, and from 6.9% to 10.5%, respectively. Of patients in full-time work pre-HCT, 50% were unemployed or on medical disability at 1-year post-HCT. Female sex (Odds ratio [OR] 0.55; 95% confidence interval [CI] 0.40-0.77), HCT-comorbidity index (HCT-CI) score =3 (OR 0.57; 95% CI 0.39-0.82), pre-HCT unemployment (OR 0.37; 95% CI 0.24-0.56), and medical disability (OR 0.44; 95% CI 0.28-0.70), development of grade 3-4 acute graft vs. host disease (OR 0.52; 95% CI 0.34-0.80), and relapse within one-year post-HCT (OR 0.34; 95% CI 0.21-0.56) were associated with lower likelihood of employment at 1-year post-HCT. Compared to myeloablative conditioning with total body irradiation (TBI), myeloablative conditioning without TBI (OR 1.71; 95% CI 1.16-2.53) was associated with higher likelihood of employment at 1-year post-HCT. Graduate school level education (OR 2.47; 95% CI 1.49-4.10) was also associated with higher likelihood of employment at 1-year post-HCT. CONCLUSIONS While the work status among YA HCT survivors continued to improve over time, a substantial subset became or remained unemployed or on medical disability. These findings underscore the need for effective return to work supportive interventions in this population.
-
5.
Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation
Phelan, R., Im, A., Hunter, R. L., Inamoto, Y., Lupo-Stanghellini, M. T., Rovo, A., Badawy, S. M., Burns, L., Eissa, H., Murthy, H. S., et al
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. OBJECTIVE Here, we provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. STUDY DESIGN We utilized systematic review methodology to summarize incidence, risk factors, screening, prevention and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research. RESULTS Most of the evidence regarding male GvHD is still based on limited data, precluding strong therapeutic recommendations. We therefore recommend to systematically screen for male genital GvHD regularly and report it to large registries to allow for a better understanding. Future research should also address treatment since little published evidence is available to date. Male-specific endocrine consequences of HCT include hypogonadism which may also affect bone health. Since the evidence is scarce, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, which warrants offering sperm preservation in all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, hence the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent than in the general population; however, subsequent malignancies in general seem to be more prevalent in males than females, and special attention should be given to skin and oral mucosa. CONCLUSION Male-specific late effects, probably more under-reported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplant physicians and specialists from other involved disciplines. Future research should be directed towards better data collection on male-specific late effects and on studies about the interrelationship between these late effects, to allow the development of evidence based effective management practices.
-
6.
Subsequent neoplasms and late mortality in children undergoing allogeneic transplantation for nonmalignant diseases
Kahn, J. M., Brazauskas, R., Tecca, H. R., Bo-Subait, S., Buchbinder, D., Battiwala, M., Flowers, M. E. D., Savani, B. N., Phelan, R., Broglie, L., et al
Blood advances. 2020;4(9):2084-2094
-
-
Free full text
-
Abstract
We examined the risk of subsequent neoplasms (SNs) and late mortality in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) for nonmalignant diseases (NMDs). We included 6028 patients (median age, 6 years; interquartile range, 1-11; range, <1 to 20) from the Center for International Blood and Marrow Transplant Research (1995-2012) registry. Standardized mortality ratios (SMRs) in 2-year survivors and standardized incidence ratios (SIRs) were calculated to compare mortality and SN rates with expected rates in the general population. Median follow-up of survivors was 7.8 years. Diagnoses included severe aplastic anemia (SAA; 24%), Fanconi anemia (FA; 10%), other marrow failure (6%), hemoglobinopathy (15%), immunodeficiency (23%), and metabolic/leukodystrophy syndrome (22%). Ten-year survival was 93% (95% confidence interval [95% CI], 92% to 94%; SMR, 4.2; 95% CI, 3.7-4.8). Seventy-one patients developed SNs (1.2%). Incidence was highest in FA (5.5%), SAA (1.1%), and other marrow failure syndromes (1.7%); for other NMDs, incidence was <1%. Hematologic (27%), oropharyngeal (25%), and skin cancers (13%) were most common. Leukemia risk was highest in the first 5 years posttransplantation; oropharyngeal, skin, liver, and thyroid tumors primarily occurred after 5 years. Despite a low number of SNs, patients had an 11-fold increased SN risk (SIR, 11; 95% CI, 8.9-13.9) compared with the general population. We report excellent long-term survival and low SN incidence in an international cohort of children undergoing HCT for NMDs. The risk of SN development was highest in patients with FA and marrow failure syndromes, highlighting the need for long-term posttransplantation surveillance in this population.
-
7.
Bone Health Management After Hematopoietic Cell Transplantation: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy
Bar, M., Ott, S. M., Lewiecki, E. M., Sarafoglou, K., Wu, J. Y., Thompson, M. J., Vaux, J. J., Dean, D. R., Saag, K. G., Hashmi, S. K., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2020
Abstract
Bone health disturbances occur commonly after hematopoietic cell transplantation (HCT) with loss of bone mineral density (BMD) and avascular necrosis (AVN) being foremost. BMD loss is related to pre-transplant chemotherapy and radiation exposures, immunosuppressive therapy for graft-versus-host-disease (GVHD), and results from deficiencies in growth or gonadal hormones, disturbances in calcium and vitamin D homeostasis, as well as osteoblast and osteoclast dysfunction. While the pathophysiology of AVN remains unclear, high-dose glucocorticoid exposure is the most frequent association. Different societal treatment guidelines for osteoporosis exist but focus mainly on menopausal-associated osteoporosis. HCT survivors comprise a distinct population with unique comorbidities, making general approaches to bone health management sometimes inappropriate. To address a core set of 16 frequently asked questions (FAQ) relevant to bone health in HCT, the American Society of Transplant and Cellular Therapy (ASTCT) Committee on Practice Guidelines convened a panel of experts in HCT, adult and pediatric endocrinology, orthopedics and oral medicine. Due to a lack of relevant prospective controlled clinical trials that specifically address bone health in HCT, the answers to the presented FAQs rely on evidence derived from retrospective HCT studies, results extrapolated from prospective studies in non-HCT settings, relevant societal guidelines, and expert panel opinion. Given heterogenous comorbidities and needs of individual HCT recipients, answers to FAQs in this article should be considered as general recommendations with good medical practice and judgment ultimately dictating care of individual patients. Readers are referred to the supplement for answers to additional FAQs that did not make the core set.
-
8.
Lower Genital Tract Precancer and Cancer in Hematopoietic Cell Transplant Survivors and the Role of HPV: A Systematic Review and Future Perspectives
Tanweer, M. S., Aljurf, M., Savani, B. N., Iqbal, P. K., Hashmi, S.
Clinical Hematology International. 2019;1(3):142-153
Abstract
Female recipients of hematopoietic cell transplant (HCT) may develop lower genital tract (LGT) dysplasia or new malignancies. A comprehensive systematic review to delineate the occurrence and risk factors for post-HCT LGT precancer and cancer in women was conducted via electronic search of the Cochrane Library, PubMed, Embase, Wiley Online Library, from 1990 to 2018. All studies on the risk, presentation, or incidence of LGT (cervix, vulva, vagina) precancer or cancer post-HCT were included. Reviews, case reports, meta-analysis, book chapters, and studies without the relevant clinical outcomes were excluded. Post-HCT incidence and risk factors for developing LGT precancer or cancer were assessed and determined. Twenty-two out of the original 344 studies met the selection criteria. The risk of LGT cancers in allo-HCT recipients was found to be significantly higher than in the general population, with the standardized incidence ratios of 1.5-48 for cervical cancer and from 19 to 287 for dysplasia. Our review portrays an increased risk of premalignant and malignant neoplasms of female LGT, which have an incompletely described epidemiology and outcomes. Similar to other immunocompromised states, HCT recipients require specific cervical screening guidelines and can greatly benefit from HPV vaccinations. However, there is a lack of prospective data regarding optimum cervical screening in HCT recipients and limited programs offer HPV vaccinations worldwide.
-
9.
Predictors of lost to follow-up among pediatric and adult hematopoietic cell transplant survivors: A report from the Center for International Blood and Marrow Transplant Research
Buchbinder, D., Brazauskas, R., Bo-Subait, K., Ballen, K., Parsons, S., John, T., Hahn, T., Sharma, A., Steinberg, A., D'Souza, A., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
BACKGROUND Follow-up is integral for hematopoietic cell transplant (HCT) care to ensure surveillance and intervention for complications. We characterized the incidence of, and predictors for, being lost to follow-up. METHODS Two-year survivors of first allogeneic (10,367 adults and 3,865 children) or autologous (7,291 adults and 467 children) HCT for malignant/non-malignant disorders from 2002-2013 reported to the Center for International Blood and Marrow Transplant Research were selected. The cumulative incidence of being lost to follow-up (defined as having missed 2 consecutive follow-up reporting periods) was calculated. Marginal Cox models (adjusted for center effect) were fit to evaluate predictors. RESULTS The 10-year cumulative incidence of being lost to follow-up among adult allogeneic and autologous HCT survivors was 13% (95% CI, 12-14) and 15% (95% CI, 14-16), respectively. Among pediatric HCT survivors, estimates were 25% (95% CI, 24-27) and 24% (95% CI, 20-29), respectively. In adult allogeneic HCT survivors, younger age, non-malignant disease, public/no insurance (reference: private), living farther from the HCT center, and being unmarried were associated with being lost to follow-up. For adult autologous HCT survivors, older age and testicular/germ cell tumor (reference: non-Hodgkin lymphoma) were associated with greater risk of being lost to follow-up. Among pediatric allogeneic HCT survivors, older age, public/no insurance (reference: private), and non-malignant disease were associated with being lost to follow-up. Among pediatric autologous HCT survivors, older age was associated with greater risk of being lost to follow-up. CONCLUSION Follow-up focusing on minimizing attrition in high-risk groups is needed to ensure surveillance for late effects.
-
10.
Risk of acute myeloid leukemia and myelodysplastic syndrome after autotransplants for lymphomas and plasma cell myeloma
Radivoyevitch, T., Dean, R. M., Shaw, B. E., Brazauskas, R., Tecca, H. R., Molenaar, R. J., Battiwalla, M., Savani, B. N., Flowers, M. E. D., Cooke, K. R., et al
Leukemia research. 2018
-
-
Free full text
-
Full text
-
Editor's Choice
Abstract
BACKGROUND Exposures to DNA-damaging drugs and ionizing radiations increase risks of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). METHODS 9028 recipients of hematopoietic cell autotransplants (1995-2010) for Hodgkin lymphoma (HL; n = 916), non-Hodgkin lymphoma (NHL; n = 3546) and plasma cell myeloma (PCM; n = 4566), reported to the CIBMTR, were analyzed for risk of subsequent AML or MDS. RESULTS 335 MDS/AML cases were diagnosed posttransplant (3.7%). Variables associated with an increased risk for AML or MDS in multivariate analyses were: (1) conditioning with total body radiation versus chemotherapy alone for HL (HR = 4.0; 95% confidence interval [1.4, 11.6]) and NHL (HR = 2.5 [1.1, 2.5]); (2) ≥3 versus 1 line of chemotherapy for NHL (HR = 1.9 [1.3, 2.8]); and (3) subjects with NHL transplanted in 2005-2010 versus 1995-1999 (HR = 2.1 [1.5, 3.1]). Using Surveillance, Epidemiology and End Results (SEER) data, we found risks for AML/MDS in HL, NHL and PCM to be 5-10 times the background rate. In contrast, relative risks were 10-50 for AML and approximately 100 for MDS in the autotransplant cohort. CONCLUSIONS There are substantial risks of AML and MDS after autotransplants for HL, NHL and PCM.