Favorable Outcomes in Patients Surviving 5 or More Years after Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies

Abstract

Allogeneic hematopoietic stem cell transplantation (SCT) is a curative treatment for some hematological malignancies. As the overall number of survivors continues to increase, studies systematically examining outcomes in long-term survivors are needed. We studied the clinical and quality of life outcomes in SCT recipients surviving five or more years from SCT. Since 1993, 262 patients with hematological malignancies received a T cell depleted myeloablative SCT from an HLA-identical sibling at a single center. Ninety-two survived beyond 5 years from SCT (median follow-up 9.4 years, range 5.1-15.3). Median age at transplantation was 35 years (range 10 - 56). Twenty-two (24%) received a bone marrow transplant, and 70 (76%) received a peripheral blood SCT. Of the 92 survivors, 60 completed quality of life measures. The main outcomes examined were chronic graft-versus-host-disease (cGVHD), disease relapse, survival, health-related quality of life (HRQL) (Functional Assessment of Cancer Therapy-General), physical and mental health (SF-36) and symptom experience (Rotterdam Symptom Checklist). Seventy-five (82%) of 92 survivors no longer required systemic immunosuppressive treatment (IST). Four (4.3%) relapsed with leukemia at a median of 8.5 years (range 6.2 -14.0) after SCT. Four (4.3%) died between 7.4 and 13.4 years post SCT (1 relapse, 1 lung cancer, 1 pneumonia, 1 brain hemorrhage). Most survivors beyond 5 years had an excellent performance status with no difference in physical and mental health and higher HRQL scores (p =0.02) compared with population norms. Although physical and psychological symptom distress was low, those with higher symptom distress experienced inferior HRQL. These results show that five or more years after T cell depleted SCT for hematological malignancy most individuals survive disease free with an excellent performance status, preserved physical and psychological health, and excellent HRQL.

Adverse psychological outcomes in long-term survivors of hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study (BMTSS)

“…[18][19][20][21][22][23][24][25][26] This inconsistency in the reports is likely because of incomplete long-term follow-up of cohorts, resulting in participation bias of the relatively small cohorts of participants, and varied outcome measures used across studies. Longitudinal studies carry the advantage of a pre-HCT baseline assessment, and the ability to describe recovery after HCT, but are limited by relatively short follow-up (1-5 years), and small number of subjects when the follow-up extends beyond 3 years.…”

Donor lymphocyte count and thymic activity predict lymphocyte recovery and outcomes after matched-sibling hematopoietic stem cell transplant

“…Characteristics intrinsic to the donor such as HLA sensitization, viral exposure, the type of killer immunoglobulinlike receptors (KIR) on natural killer cells, and Treg frequencies are already known to influence transplant outcome. [12][13][14][15][16] However, the contribution of mature donor lymphocytes infused at the time of transplantation has not been fully defined. 17 To explore the influence of immunological characteristics of the donor further, we studied donor lymphocyte counts in a series of patients undergoing HSCT to identify the potential contribution of donor regulatory and conventional T lymphocyte populations to immune recovery and transplant outcomes.…”

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

“…4 Subsets of patients after all types of transplants experience late health-related quality of life (HRQOL) deficits and functional impairment; 5 this effect is variable with other subgroups experiencing preserved patient-reported outcomes (PROs), relative to normative values. 6 Investigators and clinicians have attempted to determine who is 'fit' for transplant to inform pre-HCT counseling, selection of suitable HCT candidates and identification of vulnerable HCT recipients at risk for treatment-related complications. 7 Age remains the most commonly used surrogate variable for HCT 'fitness,' with specific measures of end-organ function also being used.…”