Late Effects in Survivors of Acute Leukemia Treated with Hematopoietic Cell Transplantation: a Report from the Bone Marrow Transplant Survivor Study

The Bone Marrow Transplant Survivor Study is a retrospective cohort study in which participants who received HCT between 1974–1998 and survived for ≥2 yr completed a 255 item questionnaire on late effects occurring after HCT. There were 281 survivors with AML and 120 with ALL. Siblings of participants (n=319) were recruited for comparison. Median age at interview was 36.5 yr for survivors and 44yr for siblings. Median follow-up after HCT was 8.4 yr. Conditioning included TBI in 86% of AML and 100% of ALL subjects. The frequencies of late effects did not differ between ALL and AML survivors. Compared to siblings, survivors had a higher frequency of diabetes, hypothyroidism, osteoporosis, exercise induced shortness of breath (EISB), neurosensory impairments, and problems with balance, tremor or weakness. In multivariable analysis, the risk of these outcomes did not differ by diagnosis. Survivors after allogeneic HCT had higher odds of diabetes (odds ratio [OR] 3.9, p=0.04), osteoporosis (OR 3.1, p=0.05), abnormal sense of touch (OR 2.6, p=0.02) and to report their overall health as fair or poor (OR 2.2, p=0.03). Ongoing surveillance for these late effects and appropriate interventions are required to improve the health status of ALL and AML survivors after HCT.