Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Acute Leukemias

Late effects in survivors of acute leukemia treated with hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study

Leukemia volume 24, pages 2039–2047 (2010)Cite this article

Subjects

Abstract

The Bone Marrow Transplant Survivor Study is a retrospective cohort study in which participants who received hematopoietic cell transplantation (HCT) between 1974 and 1998 and survived for ⩾2 years completed a 255-item questionnaire on late effects occurring after HCT. There were 281 survivors with acute myeloid leukemia (AML) and 120 with acute lymphoblastic leukemia (ALL). Siblings of participants (n=319) were recruited for comparison. Median age at interview was 36.5 years for survivors and 44 years for siblings. Median follow-up after HCT was 8.4 years. Conditioning included total body irradiation in 86% of AML and 100% of ALL subjects. The frequencies of late effects did not differ between ALL and AML survivors. Compared with siblings, survivors had a higher frequency of diabetes, hypothyroidism, osteoporosis, exercise-induced shortness of breath, 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 reported 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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Pasquini MC, Wang Z . Current use and outcome of hematopoietic stem cell transplantation: Part I—CIBMTR Summary Slides, 2009. CIBMTR Newsletter (serial online); 2009, 7–11.

  2. Hahn T, Wall D, Camitta B, Davies S, Dillon H, Gaynon P et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in children: an evidence-based review. Biol Blood Marrow Transplant 2005; 11: 823–861.

    Article  Google Scholar 

  3. Hahn T, Wall D, Camitta B, Davies S, Dillon H, Gaynon P et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in adults: an evidence-based review. Biol Blood Marrow Transplant 2006; 12: 1–30.

    Article  CAS  Google Scholar 

  4. Kiehl MG, Kraut L, Schwerdtfeger R, Hertenstein B, Remberger M, Kroeger N et al. Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. J Clin Oncol 2004; 22: 2816–2825.

    Article  Google Scholar 

  5. Baker KS, Gurney JG, Ness KK, Bhatia R, Forman SJ, Francisco L et al. Late effects in survivors of chronic myeloid leukemia treated with hematopoietic cell transplantation: results from the Bone Marrow Transplant Survivor Study. Blood 2004; 104: 1898–1906.

    Article  CAS  Google Scholar 

  6. Majhail NS, Ness KK, Burns LJ, Sun CL, Carter A, Francisco L et al. Late effects in survivors of Hodgkin and non-Hodgkin lymphoma treated with autologous hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Biol Blood Marrow Transplant 2007; 13: 1153–1159.

    Article  Google Scholar 

  7. Baker KS, DeFor TE, Burns LJ, Ramsay NK, Neglia JP, Robison LL . New malignancies after blood or marrow stem-cell transplantation in children and adults: incidence and risk factors. J Clin Oncol 2003; 21: 1352–1358.

    Article  Google Scholar 

  8. Bhatia S, Ramsay NK, Steinbuch M, Dusenbery KE, Shapiro RS, Weisdorf DJ et al. Malignant neoplasms following bone marrow transplantation. Blood 1996; 87: 3633–3639.

    CAS  Google Scholar 

  9. Kolb HJ, Socie G, Duell T, Van Lint MT, Tichelli A, Apperley JF et al. Malignant neoplasms in long-term survivors of bone marrow transplantation. Late Effects Working Party of the European Cooperative Group for Blood and Marrow Transplantation and the European Late Effect Project Group. Ann Intern Med 1999; 131: 738–744.

    Article  CAS  Google Scholar 

  10. Socie G, Curtis RE, Deeg HJ, Sobocinski KA, Filipovich AH, Travis LB et al. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia. J Clin Oncol 2000; 18: 348–357.

    Article  CAS  Google Scholar 

  11. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 2007; 110: 3784–3792.

    Article  CAS  Google Scholar 

  12. Bhatia S, Robison LL, Francisco L, Carter A, Liu Y, Grant M et al. Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study. Blood 2005; 105: 4215–4222.

    Article  CAS  Google Scholar 

  13. Louie AD, Robison LL, Bogue M, Hyde S, Forman SJ, Bhatia S . Validation of self-reported complications by bone marrow transplantation survivors. Bone Marrow Transplant 2000; 25: 1191–1196.

    Article  CAS  Google Scholar 

  14. Berger C, Le-Gallo B, Donadieu J, Richard O, Devergie A, Galambrun C et al. Late thyroid toxicity in 153 long-term survivors of allogeneic bone marrow transplantation for acute lymphoblastic leukaemia. Bone Marrow Transplant 2005; 35: 991–995.

    Article  CAS  Google Scholar 

  15. Faraci M, Barra S, Cohen A, Lanino E, Grisolia F, Miano M et al. Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant. Int J Radiat Oncol Biol Phys 2005; 63: 1568–1575.

    Article  Google Scholar 

  16. Thomas O, Mahe M, Campion L, Bourdin S, Milpied N, Brunet G et al. Long-term complications of total body irradiation in adults. Int J Radiat Oncol Biol Phys 2001; 49: 125–131.

    Article  Google Scholar 

  17. Fahnehjelm KT, Tornquist AL, Olsson M, Winiarski J . Visual outcome and cataract development after allogeneic stem-cell transplantation in children. Acta Ophthalmol Scand 2007; 85: 724–733.

    Article  Google Scholar 

  18. Kal HB, ML VANK-H . Induction of severe cataract and late renal dysfunction following total body irradiation: dose-effect relationships. Anticancer Res 2009; 29: 3305–3309.

    Google Scholar 

  19. Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socie G, Travis LB et al. Solid cancers after bone marrow transplantation. N Engl J Med 1997; 336: 897–904.

    Article  CAS  Google Scholar 

  20. Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood 2007; 109: 1765–1772.

    Article  CAS  Google Scholar 

  21. Taskinen M, Saarinen-Pihkala UM, Hovi L, Lipsanen-Nyman M . Impaired glucose tolerance and dyslipidaemia as late effects after bone-marrow transplantation in childhood. Lancet 2000; 356: 993–997.

    Article  CAS  Google Scholar 

  22. Leake E, Smith WG . Diffuse interstitial pulmonary fibrosis after busulphan therapy. Lancet 1963; 2: 432–434.

    Article  CAS  Google Scholar 

  23. Kasai M, Kiyama Y, Watanabe M, Seto K, Matsuura A, Tanaka J et al. Toxicity of high-dose busulfan and cyclophosphamide as a preparative regimen for bone marrow transplantation. Transplant Proc 1992; 24: 1529–1530.

    CAS  Google Scholar 

  24. Wingard JR, Mellits ED, Sostrin MB, Chen DY, Burns WH, Santos GW et al. Interstitial pneumonitis after allogeneic bone marrow transplantation. Nine-year experience at a single institution. Medicine (Baltimore) 1988; 67: 175–186.

    Article  CAS  Google Scholar 

  25. Fraser CJ, Bhatia S, Ness K, Carter A, Francisco L, Arora M et al. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood 2006; 108: 2867–2873.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported in part by grants from the National Institute of Health (R01 CA078938 (SB), P01 CA 30206 (SJF), K23 CA85503-01 (KSB)), and the Leukemia Lymphoma Society (2192) (SB).

Author information

Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    K S Baker

  2. Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA

    K K Ness

  3. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    D Weisdorf

  4. Department of Population Sciences, City of Hope, Duarte, CA, USA

    L Francisco, C-L Sun & S Bhatia

  5. Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    S Forman & S Bhatia

Authors
  1. K S Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K K Ness
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D Weisdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Francisco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C-L Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Forman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S Bhatia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K S Baker.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baker, K., Ness, K., Weisdorf, D. et al. Late effects in survivors of acute leukemia treated with hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Leukemia 24, 2039–2047 (2010). https://doi.org/10.1038/leu.2010.210

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2010.210

Keywords

This article is cited by

Search

Advanced search

Quick links