Study Finds Overall Health and Quality of Life Intact 10 Years After Stem-Cell Transplantation

Sep 16, 2005, 01:00 ET from Fred Hutchinson Cancer Research Center

    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
     "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
     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
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      Kristen Woodward

SOURCE Fred Hutchinson Cancer Research Center