The impact of smoking on outcomes among patients undergoing hematopoietic stem cell transplant for the treatment of acute leukemia

A paucity of research exists examining the potential impact of tobacco use on cancer treatment outcomes, especially among patients treated with hematopoietic stem cell transplantation (HSCT). A retrospective cohort study design was utilized to examine the impact of smoking on duration of hospitalization and overall survival among 148 consecutive patients undergoing HSCT for treatment of acute leukemia from 1999 to 2005. Of the 148 patients, 15% reported current smoking, 30% former smoking, and 55% never used tobacco. Patients were followed for a median 3.5 years (Interquartile Range= 2.1-5.5). Compared to no history of smoking, current smoking was associated with worse pre-HSCT pulmonary function tests (p< .02 in each case), more days hospitalized (46.2 versus 25.7 days, p = 0.025, and poorer overall survival (HR=1.88; 95% CI 1.09-3.25). Results were similar after multivariate adjustment, although the association with overall survival attenuated slightly (HR=1.75, 95% CI 1.00-3.06). Current smoking appears to adversely affect the number of days hospitalized post-HSCT and overall survival. Translational research focused on interventions to promote tobacco cessation may lead to improved HSCT outcomes.