Study Finds Overall Health And Quality Of Life Intact 10 Years After Stem-cell Transplantation

The findings, to be published in the Sept. 20 edition of the Journal ofClinical Oncology, is the first of its kind to follow a large group ofpatients from before their transplant through the 10-yearpost-transplant period.

"In many areas of health, our survivors are undistinguishable fromcase-matched controls who participated in this study and had not had atransplant," said lead investigator Karen Syrjala, Ph.D., head of theBiobehavorial Sciences group in the Hutchinson Center's ClinicalResearch Division.

For example, the study found that transplant survivors and case-matchedcontrols reported similar rates of hospitalization and outpatientmedical visits. They had similar rates of diseases and conditions suchas asthma, diabetes, high blood pressure, high cholesterol,osteoporosis and hypothyroidism, and they had similar psychologicalhealth, marital satisfaction and employment.

However, Syrjala and colleagues also found that transplant patients hada higher incidence of musculoskeletal problems, such as stiffness andcramping; poor long-term sexual health; and increased urinary frequencyand leaking than the control group. Long-term survivors also had higheruse rates of anti-depressant and anti-anxiety medications even thoughreported rates of depression and anxiety were about the same as that ofthe control group.

The study also reported potentially under-diagnosed problems amongsurvivors such as the bone-thinning disease osteoporosis andhypothyroidism because the reported rates of these diseases were lowerthan expected.

The researchers urge primary care providers to routinely screen forthese problems, which might otherwise be considered relevant primarilyto older populations, Syrjala said. The median age at transplant of thepatients surveyed was 36.4 years.

In all, survivors reported an average of 3.5 medical problems versus1.7 for controls, even though survivors and controls had similar ratesof hospitalization and outpatient medical visits.

Syrjala and colleagues made an important and positive observation among10 percent of the survivors who had suffered relapse and were incomplete remission at the time of the study. "The fact that patientscan relapse and still have healthy, full lives 10 years later and looklike everyone else who has gone through a transplant without relapse isreally good news," she said. "In the past, relapse after a transplantwas always thought to be a very bad sign for quality of life."

All of the patients in the study were transplanted at the HutchinsonCenter between March 1987 and March 1990. More than 400 patientsconsented to the study and after 10 years 137 transplant survivors andan equal number of controls completed a self-report of medicalproblems, symptoms and health-related quality of life. Most of thosesurveyed had been treated for leukemia or lymphoma. More thanthree-quarters received donor cells from a matched relative. There wasan almost equal split between males and females.

Survivors were asked to nominate a case-matched control participant,ideally a biologic sibling of the same gender and within five years ofage; this was achieved in 60 percent of the controls.

The study survey asked participants about 85 diseases and symptoms andto indicate whether they had these problems now, whether the diseasesor symptoms were ever a problem in the past 10 years or were no longera problem. Twenty-seven diseases or conditions emerged as the mostprevalent and were included in the final analysis. They ranged fromasthma to second cancers.

"Ten years after HCT (hematopoietic cell transplantation), the 137survivors were indistinguishable from case-matched controls in manyareas of health and psychosocial functioning, although survivorsreported a greater number of medical problems and greater limitationsin sexuality, insurance and social, emotional and physical roles," theauthors wrote. "Some of these problems are known to be associated withHCT, while others have not been recognized previously as late concerns."

This type of research is important, Syrjala said, because the number oflong-term survivors of stem-cell transplantation is increasing rapidly.For example, patients with acute leukemia or chronic myeloid leukemiawho survive without recurrent malignancy for two years after allogeneicstem-cell transplantation (the infusion of stem cells from a donor)have an 89 percent probability of surviving for five or more years.More than 45,000 people worldwide receive stem-cell transplants eachyear.

The study is important also because information on 10-year survivorshiphas been sparse. "Although research on late effects has increased,systematic information has not been available to guide oncologists orprimary care physicians in routine monitoring and management ofhealth-care needs after 10 years in this population," the authors wrote.

The National Cancer Institute funded the research.

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