Hematopoietic cell transplant (HCT) cures many hematologic malignancies, but recipients remain at high risk for chronic medical and psychological conditions, according to the first-ever study of these long-term outcomes.
“It is important to realize that once a transplant is over, it is not really over,” said Stephanie J. Lee, MD, MPH, University of Washington School of Medicine, Seattle, who commented on the findings at a press briefing.
The study showed that the burden of long-term physical and emotional morbidity experienced by survivors ≥10 years posttransplant can be substantial and often results in high utilization of specialized healthcare resources.
Can-Lan Sun, PhD, of the City of Hope Comprehensive Cancer Center, Duarte, CA, who presented the results, said that high-intensity therapeutic exposures, as well as prolonged immunosuppression regimens, can increase the risk for long-term complications after HCT, and these problems only accelerate over time.
There is a need for special clinics that would follow these patients aggressively, detect complications early, and reduce the associated morbidity, Dr Sun said.
She and her colleagues evaluated the risk for chronic medical and psychological conditions in 366 individuals who had received HCT at least 10 years earlier, along with 309 of their siblings, who served as controls. A severity score was assigned for each medical condition, and the Brief Symptom Inventory was used to describe adverse psychological conditions. The investigators also accessed health records.
The most often reported severe or life-threatening chronic health conditions included myocardial infarction, stroke, blindness, diabetes, musculoskeletal problems, and subsequent malignancies. The 15-year cumulative incidence of any chronic health condition was 71%, and for severe life-threatening conditions or death was 40%.
Compared with age- and sex-matched siblings, HCT survivors had a 5.6 times increased risk for a severe/life-threatening condition. The cumulative incidence of these problems did not differ by type or HCT.
Anxiety and depression scores were comparable between survivors and their siblings, but somatic distress was more common among transplant recipients. Survivors were 2.7 times more likely to report somatic distress. In addition, female sex, low household income, and poor self-rated health status were associated with even higher risks for somatic distress.
The vast majority (90%) of HCT survivors reported having health insurance coverage, which the investigators noted was “fortunate,” considering their need for ongoing specialized care.