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Survivorship after Autologous Hematopoietic Cell Transplantation for Lymphoma and Multiple Myeloma: Late Effects and Quality of Life
Georges, G. E., Bar, M., Onstad, L., Yi, J. C., Shadman, M., Flowers, M. E., Carpenter, P. A., Stewart, S., Lee, S. J., Holmberg, L. A.
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Abstract
Although autologous hematopoietic cell transplantation (AHCT) is standard therapy for patients with lymphoma and multiple myeloma (MM), few studies have addressed late effects and quality of life (QOL) for long-term survivors after AHCT. Using long-term follow-up (LTFU) annual questionnaires with self-reported outcomes, we surveyed 665 patients who were ≥5 years after AHCT for the diagnosis of lymphoma or MM. Three-hundred and eighty-nine patients completed the questionnaire (58% response rate) a median of 11 (range 5-30) years after AHCT. The median age (years, range) among 268 lymphoma patients was 63 (22-88), and for 121 multiple myeloma patients was 69 (34-84). The most commonly reported medical conditions (>10% incidence) included: sexual dysfunction, history of shingles, cataracts, osteoporosis or osteopenia, joint replacement, and skin cancer. Current medication use was more frequent in MM patients for: infection prevention/treatment (19% multiple myeloma vs 5% lymphoma, p<.001), hypertension (41% vs. 26%, p=.004), osteoporosis (23% vs. 10%, p=<0.001), and pain (33% vs. 11%, p<.001). Treated hypothyroidism was more common in lymphoma patients. In multivariate analysis combining lymphoma and MM, worse physical functioning was associated with older age, shorter time since AHCT, comorbidities, relapse and treatment for depression and/or pain. Worse mental functioning was associated with younger age and treatment for anxiety, depression or pain. In conclusion, AHCT survivors report generally good QOL but many late effects and symptoms that are potentially amenable to intervention.