Late morbidity and mortality after autologous blood or marrow transplantation for lymphoma in children, adolescents and young adults-a BMTSS report.

in Leukemia by Anna Sällfors Holmqvist, Qingrui Meng, Chen Dai, Lindsey Hageman, Wendy Landier, Jessica Wu, Liton F Francisco, Elizabeth Schlichting Ross, Nora Balas, Alysia Bosworth, Hok Sreng Te, Ravi Bhatia, Joseph Rosenthal, F Lennie Wong, Daniel Weisdorf, Saro H Armenian, Smita Bhatia

TLDR

  • The study found that survivors of autologous BMT for lymphoma performed at age <40 are at a higher risk for late morbidity and mortality, and that factors such as age at BMT, pre-BMT radiation, and year of BMT are associated with an increased risk of life-threatening or fatal conditions.

Abstract

We determined the risk of late morbidity and mortality after autologous blood or marrow transplantation (BMT) for lymphoma performed before age 40. The cohort included autologous BMT recipients who had survived ≥2 years after transplantation (N = 583 [HL = 59.9%; NHL = 40.1%]) and a comparison cohort (N = 1070). Participants self-reported sociodemographics and chronic health conditions. A severity score (grade 3 [severe], 4 [life threatening] or 5 [fatal]) was assigned to the conditions using CTCAE v5.0. Logistic regression estimated the odds of grade 3-4 conditions in survivors vs. comparison subjects. Proportional subdistribution hazards models identified predictors of grade 3-5 conditions among BMT recipients. Median age at BMT was 30.0 years (range: 2.0-40.0) and median follow-up was 9.8 years (2.0-32.1). Survivors were at a 3-fold higher adjusted odds for grade 3-4 conditions (95% CI = 2.3-4.1) vs. comparison subjects. Factors associated with grade 3-5 conditions among BMT recipients included age at BMT (>30 years: adjusted hazard ratio [aHR] = 2.31; 95% CI = 1.27-4.19; reference: ≤21 years), pre-BMT radiation (aHR = 1.52; 95% CI = 1.13-2.03; reference: non-irradiated), and year of BMT (≥2000: aHR = 0.54; 95% CI = 0.34-0.85; reference: <1990). The 25 years cumulative incidence of relapse-related and non-relapse-related mortality was 18.2% and 25.9%, respectively. The high risk for late morbidity and mortality after autologous BMT for lymphoma performed at age <40 calls for long-term anticipatory risk-based follow-up.

Overview

  • The study examined the risk of late morbidity and mortality after autologous blood or marrow transplantation (BMT) for lymphoma performed before age 40.
  • The study included 583 survivors of autologous BMT who had lived ≥2 years after transplantation and a comparison cohort of 1070 participants.
  • The researchers aimed to identify factors that predict the development of grade 3-5 conditions, which are life-threatening or fatal, among BMT recipients.

Comparative Analysis & Findings

  • Survivors of BMT were at a 3-fold higher adjusted odds for grade 3-4 conditions compared to comparison subjects.
  • Factors associated with an increased risk of grade 3-5 conditions among BMT recipients included age at BMT, pre-BMT radiation, and year of BMT.
  • The 25-year cumulative incidence of relapse-related and non-relapse-related mortality was 18.2% and 25.9%, respectively.

Implications and Future Directions

  • The findings highlight the importance of long-term anticipatory risk-based follow-up for survivors of autologous BMT for lymphoma performed at age <40.
  • Future studies should focus on identifying optimal treatment strategies for late morbidity and mortality following autologous BMT.
  • Additionally, research should explore the relationship between BMT-related factors and late complications to develop personalized risk assessment and intervention strategies.
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