SEATTLE, Sept. 16 /PRNewswire/ -- Survivors of stem-cell transplantation
for blood cancers can expect to be just about as healthy 10 years later as
adults who have never had a transplant, according to a new study by
researchers at Fred Hutchinson Research Cancer Center.
The findings, to be published in the Sept. 20 edition of the Journal of
Clinical Oncology, is the first of its kind to follow a large group of
patients from before their transplant through the 10-year post-transplant
period.
"In many areas of health, our survivors are undistinguishable from
case-matched controls who participated in this study and had not had a
transplant," said lead investigator Karen Syrjala, Ph.D., head of the
Biobehavorial Sciences group in the Hutchinson Center's Clinical Research
Division.
For example, the study found that transplant survivors and case-matched
controls reported similar rates of hospitalization and outpatient medical
visits. They had similar rates of diseases and conditions such as asthma,
diabetes, high blood pressure, high cholesterol, osteoporosis and
hypothyroidism, and they had similar psychological health, marital
satisfaction and employment.
However, Syrjala and colleagues also found that transplant patients had a
higher incidence of musculoskeletal problems, such as stiffness and cramping;
poor long-term sexual health; and increased urinary frequency and leaking than
the control group. Long-term survivors also had higher use rates of
anti-depressant and anti-anxiety medications even though reported rates of
depression and anxiety were about the same as that of the control group.
The study also reported potentially under-diagnosed problems among
survivors such as the bone-thinning disease osteoporosis and hypothyroidism
because the reported rates of these diseases were lower than expected.
The researchers urge primary care providers to routinely screen for these
problems, which might otherwise be considered relevant primarily to older
populations, Syrjala said. The median age at transplant of the patients
surveyed was 36.4 years.
In all, survivors reported an average of 3.5 medical problems versus 1.7
for controls, even though survivors and controls had similar rates of
hospitalization and outpatient medical visits.
Syrjala and colleagues made an important and positive observation among 10
percent of the survivors who had suffered relapse and were in complete
remission at the time of the study. "The fact that patients can relapse and
still have healthy, full lives 10 years later and look like everyone else who
has gone through a transplant without relapse is really good news," she said.
"In the past, relapse after a transplant was always thought to be a very bad
sign for quality of life."
All of the patients in the study were transplanted at the Hutchinson
Center between March 1987 and March 1990. More than 400 patients consented to
the study and after 10 years 137 transplant survivors and an equal number of
controls completed a self-report of medical problems, symptoms and
health-related quality of life. Most of those surveyed had been treated for
leukemia or lymphoma. More than three-quarters received donor cells from a
matched relative. There was an almost equal split between males and females.
Survivors were asked to nominate a case-matched control participant,
ideally a biologic sibling of the same gender and within five years of age;
this was achieved in 60 percent of the controls.
The study survey asked participants about 85 diseases and symptoms and to
indicate whether they had these problems now, whether the diseases or symptoms
were ever a problem in the past 10 years or were no longer a problem.
Twenty-seven diseases or conditions emerged as the most prevalent and were
included in the final analysis. They ranged from asthma to second cancers.
"Ten years after HCT (hematopoietic cell transplantation), the 137
survivors were indistinguishable from case-matched controls in many areas of
health and psychosocial functioning, although survivors reported a greater
number of medical problems and greater limitations in sexuality, insurance and
social, emotional and physical roles," the authors wrote. "Some of these
problems are known to be associated with HCT, while others have not been
recognized previously as late concerns."
This type of research is important, Syrjala said, because the number of
long-term survivors of stem-cell transplantation is increasing rapidly. For
example, patients with acute leukemia or chronic myeloid leukemia who survive
without recurrent malignancy for two years after allogeneic stem-cell
transplantation (the infusion of stem cells from a donor) have an 89 percent
probability of surviving for five or more years. More than 45,000 people
worldwide receive stem-cell transplants each year.
The study is important also because information on 10-year survivorship
has been sparse. "Although research on late effects has increased, systematic
information has not been available to guide oncologists or primary care
physicians in routine monitoring and management of health-care needs after 10
years in this population," the authors wrote.
The National Cancer Institute funded the research.
Note for media only: To obtain a copy of the paper, "Late Effects of
Hematopoietic Cell Transplantation Among 10-Year Adult Survivors Compared with
Case-Matched Controls," please contact Carrie Housman at the American Society
of Clinical Oncology, 703-519-1423 or housmanc@asco.org.
At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of
world-renowned scientists and humanitarians work together to prevent, diagnose
and treat cancer, HIV/AIDS and other diseases. Our researchers, including
three Nobel laureates, bring a relentless pursuit and passion for health,
knowledge and hope to their work and to the world. For more information,
please visit fhcrc.org.
CONTACT
Kristen Woodward
206-667-5095
kwoodwar@fhcrc.org
SOURCE Fred Hutchinson Cancer Research Center
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Related links:
http://www.fhcrc.org
CONTACT:
Kristen Woodward of Fred Hutchinson Cancer
Research Center, +1-206-667-5095, or kwoodwar@fhcrc.org
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