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Long-Term Morbidity in AML Survivors Treated With Blood or Bone Marrow Transplantation


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As reported in the Journal of Clinical Oncology by Saro H. Armenian, DO, MPH, and colleagues, findings from the BMT Survivor Study (BMTSS) indicated that survivors of acute myeloid leukemia (AML) treated with blood or marrow transplantation (BMT) are at a markedly increased risk of severe/life-threatening conditions and poorer health status compared with unaffected siblings.

Study Details

The BMTSS is a collaboration of the University of Alabama at Birmingham, City of Hope National Medical Center, and University of Minnesota. The current analysis included 1,369 2-year survivors who underwent BMT for AML at the participating sites between 1974 and 2014 at age ≥ 21 years, and 1,310 of their unaffected siblings.


The burden of severe/life-threatening conditions is substantially higher in BMT recipients when compared with an unaffected comparison group, contributing to an increasing incidence of non–relapse-related mortality over time. Chronic graft-vs-host disease was an important risk factor for severe/life-threatening/fatal conditions among BMT recipients, informing the need for close monitoring to anticipate and manage morbidity.
— Saro H. Armenian, DO, MPH, and colleagues

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Key Findings

Survivors were significantly more likely than siblings to have any chronic severe/life-threatening condition (prevalence = 54.9% vs 28.5%; odds ratio [OR] = 3.8, 95% confidence interval [CI] = 3.1–4.7, P < .001) and multiple conditions (23.9% vs 7.8%; OR = 4.3, 95% CI = 3.3–5.6, P < .001). Significantly increased risks included those for subsequent malignant neoplasms (OR = 16.9, 95% CI = 11.5–24.8), diabetes (OR = 4.6, 95% CI = 2.8–7.5), venous thromboembolism (OR = 3.5, 95% CI = 2.3–5.2), cataracts (OR = 2.8, 95% CI = 2.1–3.8), and undergoing joint replacements (OR = 1.5, 95% CI = 1.1–2.1).

Survivors were also more likely vs siblings to report poor general health (OR = 3.8, 95% CI = 2.8–5.1), functional impairment (OR = 2.9, 95% CI = 2.3–3.6), activity limitation (OR = 3.7, 95% CI = 3.0–4.5), pain (OR = 2.2, 95% CI = 1.7–2.7), and anxiety or fears (OR = 2.4, 95% CI = 1.8–3.1).

Among survivors, the 20-year cumulative incidence of severe/life-threatening or fatal conditions was 68%. History of chronic graft-vs-host disease was associated with increased risk of pulmonary disease (hazard ratio [HR] = 3.1, 95% CI = 1.0–9.3), cataracts (HR = 2.6, 95% CI = 1.4–3.8), and venous thromboembolism (HR = 2.3, 95% CI = 1.3–4.7).

Among survivors, relapse-related mortality plateaued at 30% at approximately 10 to 12 years after BMT. Non–relapse-related mortality approached 50% at 30 years and began to exceed relapse-related mortality at approximately 12 years. Among 2-year survivors, the most common causes of death were primary disease (43.8%) and infection (21.3%). The most common causes among 15- and 20-year survivors were subsequent malignant neoplasms (16.5% and 21.4%) and cardiovascular disease (16.5% and 16.7%).

The investigators concluded, “The burden of severe/life-threatening conditions is substantially higher in BMT recipients when compared with an unaffected comparison group, contributing to an increasing incidence of non–relapse-related mortality over time. Chronic graft-vs-host disease was an important risk factor for severe/life-threatening/fatal conditions among BMT recipients, informing the need for close monitoring to anticipate and manage morbidity.”

Dr. Armenian, of City of Hope Comprehensive Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute and Leukemia & Lymphoma Society. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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