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Transplant Toxicities

Adverse health events and late mortality after pediatric allogeneic hematopoietic SCT—two decades of longitudinal follow-up

Bone Marrow Transplantation volume 50, pages 850–857 (2015)Cite this article

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Abstract

Treatment-related late toxicities after pediatric allogeneic hematopoietic SCT (allo-HSCT) are increasingly important as long-term survival has become an expected outcome for many transplanted children and adolescents. In a retrospective cohort study, we assessed long-term health outcomes in 204 allo-HSCT survivors transplanted in childhood or adolescence (<20 years) between 1978 through 2000 after a median follow-up time of 12 (range 4–28) years. Data on conditioning regimen, adverse health events (AE) and growth and hormonal substitutions (hormone replacement therapies (HRTs)) were obtained from medical records. AEs were graded retrospectively according to Common Terminology Criteria for Adverse Events v3.0. Late deaths (⩾48 months after allo-HSCT) were evaluated separately. Multivariate analysis demonstrated that chronic GVHD (P<0.000) and longer follow-up time (P<0.05) correlated with AEs, whereas CY-based conditioning was inversely correlated (P<0.002). TBI and longer follow-up duration predicted more severe AEs (P<0.001 and P<0.001, respectively). HRTs were more frequent after TBI. Diabetes type II, dyslipidemia and hypertension were detected in 9, 7 and 7% of the survivors, respectively. Late deaths (n=22) were most frequently due to pulmonary failure (n=7), followed by secondary malignancy (n=5). The occurrence of AEs after pediatric allo-HSCT is high and likely to increase during extended follow-up, particularly in patients who have received TBI.

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Acknowledgements

We thank Björn Jonsson for help with statistical analysis and Jaana Vettenranta, Satu Ranta, Pirjo Valtonen and Otto Wilhelmsson for skillful technical assistance. This study was supported by grants from the Swedish Childhood Cancer Foundation, Stockholm City Council, the Finnish Cancer Society, the Finnish Pediatric Research Foundation, Paulo Foundation, the Nona and Kullervo Väre Foundation and the Academy of Finland.

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Authors and Affiliations

  1. Departments of Women’s and Children’s Health, Karolinska University Hospital Huddinge, Stockholm, Sweden

    M Wilhelmsson

  2. Astrid Lindgren Children’s Hospital, Karolinska University Hospital Huddinge, Stockholm, Sweden

    M Wilhelmsson, B Borgström, B Gustafsson & J Winiarski

  3. Division of Hematology–Oncology and Stem Cell Transplantation, Children’s Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland

    A Vatanen, M Taskinen, U M Saarinen-Pihkala & K Jahnukainen

  4. Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden

    B Borgström, B Gustafsson & J Winiarski

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  1. M Wilhelmsson
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Correspondence to M Wilhelmsson.

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Wilhelmsson, M., Vatanen, A., Borgström, B. et al. Adverse health events and late mortality after pediatric allogeneic hematopoietic SCT—two decades of longitudinal follow-up. Bone Marrow Transplant 50, 850–857 (2015). https://doi.org/10.1038/bmt.2015.43

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