There is an increased risk of MDS/AML following ABMT/PSCT for lymphoid malignancies. NHL patients age > or = 40 years at the time of transplant and who received TBI are at greatest risk.

We evaluated whether or not a patient's area of primary residence is an independent risk factor for overall survival (OS) after HLA-identical sibling or autologous hematopoietic stem cell transplantation (HSCT). This retrospective cohort study included patients who underwent autologous (n = 1739) or HLA-identical sibling (n = 267) HSCT to treat a hematologic malignancy between 1983 and 2004 at the University of Nebraska Medical Center. Primary area of residence, using the patient's zip code, was categorized as either urban or rural (including isolated, small rural, or large rural) according to the Rural Urban Commuting Area Codes (RUCA) classification system. An association between area of primary residence and survival was examined using Cox proportional hazards regression analysis while adjusting for patient-, disease-, and treatment-related variables. Patients from rural areas who received autologous HSCT had a higher relative risk of death (relative risk = 1.18; P = .016) than urban patients who underwent the same procedure. Survival rates in patients from rural and urban locations are as follows: 1 year, 73% vs 78% (P = .04); 5 year, 48% vs 54% (P = .012). We failed to detect a significant difference in the risk of death according to primary area of residence in the HLA-identical sibling HSCT cohort, although this may be from lack of statistical power. Our findings suggest that the primary location of a patient's residence may be an independent risk factor for survival after HSCT.

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Studies examining follow-up care among cancer survivors have increased in number, and are mostly focused on who best provides care. It is not known whether having single or multiple physicians as follow-up providers has outcome implications. We prospectively studied the association between number of follow-up providers among survivors of hematologic malignancies and serious medical utilization (defined as emergency room visits or hospitalizations) within a 6-month period. Patients completing treatment (n = 314) were included. Patients seeing multiple follow-up providers were more likely to be younger, to reside farther away from the university hospital, to have prescription drug insurance, to have received prior cancer treatment, to have multiple myeloma, and to have undergone hematopoietic cell transplant as a part of cancer treatment. Multivariate analysis showed that the number of follow-up providers was not associated with serious medical utilization (odds ratio 1.29, 95% confidence interval 0.68–2.48, p = 0.44) after adjusting for patient factors. Our study showed that among survivors of hematologic malignancies, outcomes were not different for survivors who were seen by single or multiple follow-up providers.