Health status and quality of life in long-term survivors of childhood leukaemia: the impact of haematopoietic stem cell transplantation

Abstract

We compared late side effects and quality of life (QoL) in 430 survivors of childhood acute leukaemia based on whether they had undergone haematopoietic cell transplantation (n ¼ 142) or not (n ¼ 288). Mean age was 18.2 years and mean follow-up duration was 11.9 years. Multivariate logistic regression analyses were performed to compare the risk of each type of late effect in the two groups. Based on age, VSP-A or SF36 questionnaires were used to assess QoL. For each QoL dimension, multiple linear regression was done to construct models of association with the treatment group. Transplanted patients experienced more side effects, including height growth failure, gonadal dysfunction, hypothyroidism and cataract. Children and adolescents in the two treatment groups reported similar QoL levels for almost all dimensions except a better perception of school work by young transplanted children and more difficulties in relating to the medical staff for transplanted adolescents. In adults, two differences in physical domain of QoL were detected but the calculated effect sizes were less than 0.2 in each case, suggesting an uncertain clinical significance. In spite of a higher risk of physical adverse events in the transplanted group, very few clinically significant differences in QoL are detectable.

Health-related quality of life in survivors of BMT for paediatric malignancy: a systematic review of the literature

“…In five studies, the primary aim involved comparison of outcomes with population norms, healthy controls or other groups of sick children, 22,24,26,27,29 seven described changes in HRQL over time and pre-transplant predictors of HRQL. 7,[16][17][18]21,25,28 Sample size ranged from 22 26 to 160 21 and involved 988 children.…”

“…Studies were conducted in the US, 7,[16][17][18][19][20][21] Sweden, [22][23][24] Canada, 25 Netherlands, 26 Spain, 27 Austria 28 and France. 29 All but three 21,28,29 were single centre studies.…”

“…24 Treatment involved BMT for six cohorts, 7,18,[24][25][26][27] BMT or PBSC transplant for two 22,28 and SCT, not further specified, in four. 16,17,21,29 One or more standardized measure of HRQL (Table 3) was used in eight studies, 18,21,22,[25][26][27][28][29] but these included 12 different measures. Six generic and five cancer-specific measures were used.…”

Time-related arterial changes after allogeneic hematopoietic stem cell transplantation in children

“…t he number of long-term survivors after hematopoietic stem cell transplantation (HSCT) has increased, and, consequently, secondary morbidity and quality-of-life issues have become more and more important, especially in subjects who undergo transplantation in childhood (1,2). Endocrinopathies, including growth hormone deficiency, hypothyroidism, and hypogonadism, are the most common late effects after HSCT (1,3).…”

“…Endocrinopathies, including growth hormone deficiency, hypothyroidism, and hypogonadism, are the most common late effects after HSCT (1,3). However, metabolic (4) and cardiovascular morbidity (5), as newer entities in the field, may deserve more emphasis with elapsing time after transplantation.…”