Burden of Long-Term Morbidity Borne by Survivors of Acute Myeloid Leukemia Treated With Blood or Marrow Transplantation: The Results of the BMT Survivor Study. Issue 28 (1st October 2022)

• Record Type: Journal Article
• Authors: Armenian, Saro H.; Chen, Yanjun; Hageman, Lindsay; Wu, Jessica; Landier, Wendy; Bosworth, Alysia; Francisco, Liton; Schlichting, Elizabeth; Bhatia, Ravi; Salzman, Donna; Wong, F. Lennie; Weisdorf, Daniel J.; Forman, Stephen J.; Arora, Mukta; Bhatia, Smita
• Is Part Of: Journal of clinical oncology. Volume 40:Issue 28(2022)
• Page Start: 3278
• Page End: 3288
• Publication Date: 2022-10-01
• Subjects: Oncology -- Periodicals; Cancer -- Periodicals; Oncology; Medical Oncology; Cancérologie -- Périodiques; Cancer -- Périodiques; Cancérologie; Cancer; Oncology; Oncologia; Càncer; Periodicals; 616.994
• DOI: 10.1200/JCO.21.02829
• Languages: English
• ISSNs: 0732-183X

Abstract

Abstract : PURPOSE: Blood or marrow transplantation (BMT) is an integral part of consolidation and/or salvage therapy for patients with acute myeloid leukemia (AML). With the growing population of AML survivors, there is a need to understand the quality of their survival. MATERIALS AND METHODS: This multisite study included 1, 369 2-year survivors who underwent BMT for AML between 1974 and 2014 at age ≥ 21 years and 1, 310 siblings. Using Common Terminology Criteria for Adverse Events, severe/life-threatening and fatal chronic health conditions were identified. Multivariable regression analysis was used to compare the risk of severe/life-threatening conditions and health status between survivors and siblings, and to identify risk factors for health conditions among BMT survivors. RESULTS: The prevalence of severe/life-threatening conditions was 54.9% in BMT survivors compared with 28.5% in siblings ( P < .001), yielding 3.8-fold higher odds of severe/life-threatening conditions (95% CI, 3.1 to 4.7) among the BMT survivors. The most prevalent conditions included subsequent neoplasms, diabetes, cataracts, venous thromboembolism, and joint replacement. Survivors were more likely to report poor general health (odds ratio [OR], 3.8; 95% CI, 2.8 to 5.1), activity limitation (OR, 3.7; 95% CI, 3.0 to 4.5), and functional impairment (OR, 2.9; 95% CI, 2.3 to 3.6). Among BMT recipients, the 20-year cumulative incidence of severe/life-threatening/fatal conditions was 68%. History of chronic graft-versus-host disease was associated with a higher risk of pulmonary disease (hazard ratio [HR], 3.1; 95% CI, 1.0 to 9.3), cataract (HR, 2.6; 95% CI, 1.4 to 3.8), and venous thromboembolism (HR, 2.3; 95% CI, 1.3 to 4.7). Relapse-related mortality (RRM) plateaued at 30%, whereas non-RRM increased to 50% at 30 years. CONCLUSION: The burden of severe/life-threatening conditions is substantially higher in BMT recipients when compared with an unaffected comparison group, contributing to an increasing incidence of non-RRM over time. Chronic graft-versus-host disease was an important risk factor for severe/life-threatening/fatal conditions among BMT recipients, informing the need for close monitoring to anticipate and manage morbidity.