132: Late effects in survivors of Hodgkin’s and non-Hodgkin’s lymphoma treated with autologous hematopoietic cell transplantation: A report from the bone marrow transplant survivor study

Abstract

We conducted a retrospective cohort study to evaluate late effects of autologous hematopoietic cell transplantation (HCT) in Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) survivors. Eligible subjects received HCT at either City of Hope or University of Minnesota between 1974 and 1998, were 18 years or older at the time of interview and had survived for 2 years or more after HCT. A random sample of siblings of study participants was recruited for comparison. All participants (n=92 HL, n=184 NHL, n=319 siblings) completed a 238 item questionnaire. Median age at HCT was 39 years (range, 13-69) and median followup was 6 years (range, 2-17) since HCT. Median age at completion of survey was 46 years (range, 21-73) for HCT survivors and 44 years (range, 19-79) for siblings. Patient characteristics were similar between HL and NHL groups except a higher proportion of NHL survivors received total body irradiation (TBI) as part of their conditioning (83% vs 40%). Compared to siblings (after adjusting for age at interview and sex), HCT survivors reported a significantly higher frequency of cataracts (14% vs 4%), dry mouth (14% vs 1%), hypothyroidism (19% vs 7%), bone impairments (osteoporosis and avascular necrosis) (7% vs 3%), congestive heart failure (4% vs 0.3%), exercise induced shortness of breath (10% vs 3%), neurosensory impairments (33% vs 20%), second cancers (8% vs 2%), and inability to attend work or school due to health impairments (16% vs 2%). 84% subjects rated their overall health as good, very good or excellent compared to 95% siblings (p<0.001). Multivariate models adjusted for age at HCT and time since HCT simultaneously considered the effects of sex, diagnosis (HL vs. NHL) and conditioning regimen (TBI vs. no TBI). Compared to those receiving no TBI, patients treated with TBI based conditioning had higher risks of cataracts (odds ratio (OR) 4.9, 95% CI: 1.5-15.5) and dry mouth (OR 3.4, 95% CI: 1.1-10.4). Females had a greater likelihood of reporting hypothyroidism (OR 2.5, 95% CI: 1.3-4.7), osteoporosis (OR 8.7, 95% CI: 1.8-41.7), congestive heart failure (OR 4.3, 95% CI: 1.1-17.2) and abnormal balance, tremor or weakness (OR 2.4, 95% CI: 1.0-5.5). In conclusion, HL and NHL survivors of autologous HCT have a high prevalence of long-term health-related complications and require continued monitoring for late effects with timely introduction of appropriate interventions.