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Long-term health outcomes in survivors of childhood AML treated with allogeneic HSCT: a NOPHO–AML Study

Bone Marrow Transplantation volume 54, pages 726–736 (2019)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) improves event-free survival in acute myeloid leukemia (AML); however, the burden of late effects may be increased. We compared health-related outcomes in childhood AML survivors treated according to the NOPHO-AML protocols either with or without allo-HSCT at age < 21 years. Out of the 147 eligible AML survivors treated with allo-HSCT, 95 (65%) and 53 (75%) of their eligible siblings completed a questionnaire. Their data were compared to corresponding data collected previously from NOPHO-AML survivors treated with chemotherapy only (CT) (n = 101). The median follow-up was 12 (range 2–28) years after allo-HSCT and 47% had received total body irradiation (TBI)-based conditioning. Allo-HSCT survivors reported significantly more physical health limitations (39% vs 7%, p < 0.005), medications for cardiovascular disease (10% vs 1%, p < 0.05) and use of analgesics (32% vs 11%, p < 0.01) than CT survivors. Health problems prevented 16% of the allo-HSCT survivors from attending school or managing a job vs. 3% among CT survivors (p < 0.05). Among 73 allo-HSCT survivors (age ≥ 15 years), seven females reported natural pregnancies and three males reported unassisted conceptions in partners. Survivors of childhood AML treated with allo-HSCT experienced more physical health limitations and used more medications than the survivors treated with chemotherapy only.

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Acknowledgements

We thank the participating AML survivors and their siblings; treating oncologists and hematologists including Marianne Jarfelt, Jacek Toporski, Johan Arvidson, Päivi Lähteenmäki, and Jón R Kristinsson; Ulf Hammar for help with the statistical analyses. Financial support was received from the Swedish Childhood Cancer foundation and Mary Béves Childhood Cancer foundation. Mari Wilhelmsson was supported by the Stockholm County Council (combined clinical residency and PhD training program).

Funding

This study was supported by grants from the Swedish Childhood Cancer Foundation, Stockholm City Council, Mary Béves Foundation for Childhood Cancer Research, 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. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Mari Wilhelmsson & Kirsi Jahnukainen

  2. Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

    Mari Wilhelmsson & Jacek Winiarski

  3. Department of Paediatric and Adolescent Medicine, Rikshospitalet University Hospital, Oslo, Norway

    Heidi Glosli

  4. Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Marianne Ifversen

  5. Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Jonas Abrahamsson

  6. Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden

    Jacek Winiarski

  7. Division of Haematology-Oncology and Stem Cell Transplantation, Children’s Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland

    Kirsi Jahnukainen

  8. Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark

    Henrik Hasle

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On behalf of the Nordic Society of Pediatric Hematology and Oncology (NOPHO)

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Correspondence to Mari Wilhelmsson.

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Wilhelmsson, M., Glosli, H., Ifversen, M. et al. Long-term health outcomes in survivors of childhood AML treated with allogeneic HSCT: a NOPHO–AML Study. Bone Marrow Transplant 54, 726–736 (2019). https://doi.org/10.1038/s41409-018-0337-8

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