Recovery and Long-term Function After Hematopoietic Cell Transplantation for Leukemia or Lymphoma

Abstract

URVIVAL RATES AFTER MYELOABlative hematopoietic cell transplantation (HCT) have improved considerably during the past 30 years. 1 The growing population of patients who have survived this treatment has intensified the need to determine the course of recovery and to identify risk factors for less favorable functional outcomes. Improved understanding of recovery will facilitate more accurate informed consent, permit better planning by patients, families, and medical teams, and enable the design of interventions to improve functional recovery.Medical complications of HCT have been well documented and include chronic graft-vs-host disease (GVHD), recurrent infection, pulmonary complications, premature menopause, cataracts, osteoporosis, avascular necrosis, infertility, recurrent malignancy, and secondary malignancy. [2][3][4][5][6][7][8][9][10] Crosssectional studies have documented functional and mental health from 1 to 10 years after transplantation but have not described the course of recovery or identified pretransplantation factors that predict recovery. [11][12][13][14][15][16][17][18][19] Other studies have been limited by lack of pretransplantation baseline assessment, 20 shorter follow-up, [21][22][23][24][25] or small sample size when follow-up extends to 3 years. 26,27 We conducted a prospective, longitudinal study to examine recovery of physical and mental health and return to work after HCT for treatment of leukemia or lymphoma. Assessments be-gan before the transplantation and continued for 5 years to identify pre-

Occupational status among adult survivors following allo-SCT

“…Because of differences in study designs, as outlined in the Introduction section, it is difficult to compare studies. The RTW rate in the present study was 81%, when based only on those working before SCT, which is lower 18,19 or higher 21 than results from studies calculating the RTW rate in this way (Table 6). The proportion that reduces their working time after a cancer diagnosis varies, 31 and the same pattern is seen in the very few studies that report on part-time work among SCT survivors.…”

“…7,16,17 Prospective studies including both autologous and allo-SCT patients show that RTW improves gradually from 1 to 5 years post SCT. 18,19 At 10 years, allo-SCT patients exhibit similar levels of working full-time when compared with healthy case-matched controls (72% vs 74%). 8 However, there are several methodological problems with previous studies investigating RTW in SCT patients.…”

“…8 However, there are several methodological problems with previous studies investigating RTW in SCT patients. First, many studies combine results from auto-and allo-SCT patients, 18,19 which is not optimal because the quality-of-life scores 20 and RTW rates seems to differ significantly between those groups. 7,21 Second, occupational status before SCT is either unknown 8,14,17,[22][23][24] or gathered just before the SCT, 18,19,21 which is misleading because many patients at that time point are on sick leave because of consolidation treatments.…”

“…Third, only those who worked before SCT are included most often in these studies. 18,19,21 Finally, distinctions between those working full-or part-time are not considered. 7,16,17,19,21,22 The aim of this study was to elucidate occupational status and factors associated with work among people of working age who have undergone allo-SCT.…”

Graft-versus-host disease following marrow transplantation for aplastic anemia: different impact of two GVHD prevention strategies

“…4,5 Despite these strategies, 30-40% of patients develop acute and chronic GVHD, which not only result in morbidity and mortality but also have a negative impact on the quality of life. [4][5][6][7] Unlike hematologic malignancies, GVHD probably has no therapeutic benefit in patients with AA and prevention of GVHD is one of the most desirable goals of BMT in AA. Previous studies from St George's Hospital in London reported a favorable effect on acute and chronic GVHD in matched sibling donor and matched unrelated donor BMT for AA using in vivo anti-CD52 monoclonal antibodies (Campath-1G antibodies and alemtuzumab).…”