Chronic disease burden and frailty in survivors of childhood HSCT: a report from the St. Jude Lifetime Cohort Study

Abstract

Key Points• Childhood HSCT survivors suffer from a higher burden of severe/life-threatening conditions compared to conventional therapy survivors.• Seven percent of HSCT survivors exhibit frailty phenotype at early age, placing them at higher risk for early mortality. vs 4.6%, P , .001) conditions, and frail health (7.1% vs 1.6%, P , .001) were higher after HSCT than conventional therapy. These results underscore the need for clinical follow-up and provide data to guide the development of prevention and/or intervention strategies for this vulnerable population.

Challenges and opportunities in the care of survivors of adolescent and young adult cancers

“…As survivors age, the long‐term consequences of their cancer therapies will combine with the normal aging process, and potentially accelerate the normal aging process, creating new challenges for survivors and their providers . Studies such as the Bone Marrow Transplant Survivor Study and the St Jude Lifetime Cohort Study are examining outcomes such as premature frailty in cohorts that include survivors of AYA cancer. There are many gaps in our knowledge about long‐term outcomes in this vulnerable population.…”

Challenges and Opportunities for Childhood Cancer Drug Development

“…While cytotoxic therapies may induce complete responses in patients with solid tumor metastatic disease, treatment is rarely curative. Treatment of acute lymphoblastic leukemias has used many of the same DNA-targeted agents, with the addition of corticosteroids (prednisone and dexamethasone), cytosine arabinoside (cytarabine), 6-mercaptopurine (antimetabolites), methotrexate (antifolate), and L-asparaginase. While gains in survival have been very impressive, long-term consequences of chemoradiation therapy can be devastating (Eissa et al, 2017;Chow et al, 2018;Henderson and Oeffinger, 2018;Turcotte et al, 2018). For brain tumors, standard radiation doses (45-70 Gy) far exceed the dose thresholds for neurocognitive deficits (.18 Gy) and neuroendocrine deficits (growth hormone .18 Gy, gonadotrophins-ACTH-TRH .40 Gy).…”

A systematic approach to the endocrine care of survivors of pediatric hematopoietic stem cell transplantation

“…Endocrinopathies are among the most commonly reported late effects [5]. Survivors may benefit from early recognition of endocrinopathies because many are amenable to treatment, whereas the absence of therapy may lead to worsened general health outcomes [3]. Here, we summarize current reports of endocrine late effects resulting from pediatric HSCT, with an emphasis on gaps in knowledge and areas for further investigation and clinical improvement.…”

“…Additional treatment exposures during the immediate posttransplantation period include immunosuppressive agents, such as systemic glucocorticoids, to prevent the rejection of donor cells or to treat graft-versus-host disease (GVHD) [2]. Surviving HSCT recipients have a high risk of experiencing chronic health conditions that may appear after a variable latency period and are hence termed late effects [3,4]. Endocrinopathies are among the most commonly reported late effects [5].…”

“…Semen analysis is most informative for fertility evaluation 3. Labs are indicated in individuals exposed to TBI or abdominal radiotherapy 4.…”