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Allogenic hematopoietic stem cell transplantation (allo-HSCT) is frequently used as a curative treatment in adolescents and young adults (AYAs) with acute myeloid leukemia (AML), with more than 50% of patients experiencing long-term survival.1 However, there have been few studies on the late effects of allo-HSCT in AYAs that could help to support these patients and their age-related physiological and/or psychosocial challenges.
Catherine J. Lee, Huntsman Cancer Institute, University of Utah, US, and colleagues conducted a retrospective study to investigate the late effects, survival, and mortality up to 10 years after allo-HSCT treatment in AYAs with AML. They also compared the late effects based upon the type of myeloablative conditioning (MAC) used prior to HSCT: total body irradiation (TBI) or high-dose chemotherapy only. The results were published earlier last month in the journal Blood Advances.2
The analysis included 826 AYA patients (aged 15–39 years) with AML who had undergone allo-HSCT between 2000 and 2014; who had survived at least one-year disease-free after allo-HSCT; and had been reported to the Center for International Blood and Marrow Transplant Research (CIBMTR).
Table 1. Estimated cumulative incidence of late effects for AYA patients with AML after allo-HSCT2
*p value for comparison of TBI and chemotherapy-only MAC regimes | |||||||
|
All patients (N = 826) |
TBI (n = 390) |
Chemotherapy only (n = 436) |
|
|||
---|---|---|---|---|---|---|---|
Late effect |
No. |
95% CI |
No. |
95% CI |
No. |
95% CI |
*p value |
SNs |
0.73 |
||||||
2y |
0 |
0–1 |
0 |
0–1 |
0 |
0–1 |
|
5y |
1 |
0–2 |
1 |
0–2 |
1 |
0–2 |
|
10y |
4 |
2–6 |
3 |
1–7 |
4 |
1–8 |
|
Avascular necrosis |
0.2 |
||||||
2y |
2 |
1–4 |
3 |
2–5 |
2 |
1–3 |
|
5y |
5 |
4–7 |
7 |
4–9 |
4 |
3–7 |
|
10y |
8 |
5–10 |
9 |
6–13 |
6 |
4–9 |
|
Cataracts |
< 0.001 |
||||||
2y |
1 |
0–1 |
1 |
0–3 |
0 |
0–1 |
|
5y |
5 |
3–7 |
8 |
6–12 |
1 |
0–2 |
|
10y |
10 |
7–13 |
15 |
11–19 |
5 |
2–10 |
|
Diabetes mellitus |
0.21 |
||||||
2y |
1 |
1–2 |
3 |
1–5 |
0 |
0–1 |
|
5y |
3 |
2–4 |
4 |
2–6 |
2 |
1–4 |
|
10y |
5 |
3–7 |
5 |
3–9 |
4 |
1–8 |
|
Hypothyroidism |
0.38 |
||||||
2y |
1 |
0–1 |
1 |
0–2 |
0 |
0–1 |
|
5y |
2 |
1–3 |
2 |
1–4 |
2 |
1–3 |
|
10y |
3 |
2–5 |
4 |
2–7 |
3 |
1–5 |
|
Gonadal dysfunction |
0.98 |
||||||
2y |
4 |
2–5 |
4 |
2–6 |
3 |
2–5 |
|
5y |
7 |
5–9 |
7 |
5–10 |
6 |
4–9 |
|
10y |
10 |
8–13 |
10 |
6–13 |
11 |
7–16 |
|
This study demonstrates that late effects among AYA long-term survivors of allo-HSCT are frequent, with nearly a quarter of patients developing more than one late effect. Although the prevalence of one or more late effects were greater in those who received TBI MAC, the estimated cumulative incidences of late effects and SNs were not significantly associated with the type of MAC. The exception to this was the development of cataracts, which were more likely to develop after high-dose TBI.
Limitations of the study include a relatively short follow-up time of survivors after HSCT, therefore, conditions that are known to occur even decades after HSCT, such as cardiac events3 and SNs, would not have been captured in this cohort.
As late effects were more closely linked to cGVHD than the type of conditioning, the authors highlight the importance of developing allo-HSCT procedures and related treatments that result in less cGVHD and suggest that more comprehensive, long-term follow-ups are required in AYAs with AML.
The authors recommend systematic assessment of late effects in AYAs, which would help in developing AYA-focused survivorship guidelines and care plans, similar to those done for survivors of childhood cancers.
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