Prevalence and predictors of chronic health conditions after hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study

• Published in: Blood Vol. 116; no. 17; pp. 3129 - 3139
• Main Authors: Sun, Can-Lan, Francisco, Liton, Kawashima, Toana, Leisenring, Wendy, Robison, Leslie L., Baker, K. Scott, Weisdorf, Daniel J., Forman, Stephen J., Bhatia, Smita
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 28.10.2010; Americain Society of Hematology; American Society of Hematology
• Series: Plenary Paper
• Subjects: 1. Distinguish disease and demographic factors that can influence the rate of chronic health conditions following hematopoietic cell transplantation (HCT); 2. Specify the risk factors for chronic health conditions and organ systems more commonly affected among recipients of HCT compared with their siblings; Adolescent; Adult; Aged; and view/print certificate. For CME questions, see page 3377; Biological and medical sciences; Cohort Studies; Disclosures; Female; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Learning objectives; Male; Medical sciences; Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity; MedscapeCME Continuing Medical Education online; Middle Aged; Plenary Paper; Prevalence; review the learning objectives and author disclosures; Siblings; study the education content; Survivors; take the post-test and/or complete the evaluation at http://cme.medscape.com/journal/blood; The authors, the Associate Editor Malcolm K. Brenner, and the CME questions author Charles P. Vega, University of California, Irvine, CA, declare no competing interests; This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians; Upon completion of this activity, participants will be able to; Young Adult; Disclosures; study the education content; Upon completion of this activity, participants will be able to; review the learning objectives and author disclosures; Learning objectives; 2. Specify the risk factors for chronic health conditions and organ systems more commonly affected among recipients of HCT compared with their siblings; MedscapeCME Continuing Medical Education online; and view/print certificate. For CME questions, see page 3377; take the post-test and/or complete the evaluation at http://cme.medscape.com/journal/blood; 1. Distinguish disease and demographic factors that can influence the rate of chronic health conditions following hematopoietic cell transplantation (HCT); Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity; This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians; The authors, the Associate Editor Malcolm K. Brenner, and the CME questions author Charles P. Vega, University of California, Irvine, CA, declare no competing interests; Chronic; Prevalence; Hematology; Health; Survivor; Stem cell; Hematopoietic cell; Bone marrow; Graft; Predictive factor; Epidemiology
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2009-06-229369

Long-term survival is now an expected outcome after hematopoietic cell transplantation (HCT). However, the burden of morbidity long-term after HCT remains unknown. We examined the magnitude of risk of chronic health conditions reported by 1022 HCT survivors and their siblings (n = 309). A severity score (grades 1 [mild] through 4 [life-threatening]) was assigned to each health condition using the Common Terminology Criteria for Adverse Events, Version 3. Sixty-six percent of the HCT survivors reported at least one chronic condition; 18% reported severe/life-threatening conditions; comparable values in siblings were 39% and 8%, respectively (P < .001). The cumulative incidence of a chronic health condition among HCT survivors was 59% (95% confidence interval [CI], 56%-62%) at 10 years after HCT; for severe/life-threatening conditions or death from chronic health conditions, the 10-year cumulative incidence approached 35% (95% CI, 32%-39%). HCT survivors were twice as likely as siblings to develop a chronic condition (95% CI, 1.6-2.1), and 3.5 times to develop severe/life-threatening conditions (95% CI, 2.3-5.4). HCT survivors with chronic graft-versus-host disease were 4.7 times as likely to develop severe/life-threatening conditions (95% CI, 3.0-7.2). The burden of long-term morbidity borne by HCT survivors is substantial, and long-term follow-up of patients who received transplantation is recommended.