Health and functional status of long-term survivors of bone marrow transplantation

Thomas Duell, Maria Teresa Van Lint, Per Ljungman, André Tichclli, Gerard Sodé, Jane F. Apperley, Melanie Weiss, Amon Cohen, Elke Nekolla, Hans Jochem Kolb

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Background: Although many patients now survive the short term complications of bone marrow transplantation for life-threatening hematologic disease, information on the health and activity of long-term survivors is sparse. Objective: To evaluate the morbidity and mortality of patients surviving more than 5 years after allogeneic bone marrow transplantation. Design: Retrospective, multicenter study. Patients: 798 recipients of bone marrow transplants (477 adults, 321 children) from 43 European centers. Patients had received transplants before December 1985 and had survived at least 5 years. Patients had received allogeneic or syngeneic bone marrow for leukemia, lymphoma, inborn diseases of the hematopoietic and immune systems, and severe aplastic anemia. Measurements: Survival, clinical performance according to Karnofsky score (in increments of 10%), and social reintegration were assessed as outcomes. Patient age and sex, primary disease and status at transplantation, histocompatibility of the donor, conditioning regimen, type of prophylaxis of graft versus-host disease, and acute and chronic graft- versus-host disease were evaluated as variables. Results: For the 55 5-year survivors, actuarial mortality was 8% at 10 years and 14% at 15 years. The leading causes of death were disease recurrence (21 patients), chronic graft- versus-host disease with complicating infections and lung disease (11 patients), secondary cancer (8 patients), and the acquired immunodeficiency syndrome (AIDS) (5 patients). When patients with recurrent disease were excluded, late death was associated with chronic graft-versus host disease (P = 0.001), occurrence of secondary cancer (P = 0.001), male sex of the patient (P = 0.05), and female sex of the donor (P = 0.002). Clinical performance was normal (Karnofsky score, 100%) or minimally reduced (Karnofsky score, 90%) in 93% of patients; 89% of patients resumed full-time work or school. Reduced performance status and incomplete resumption of social activity were associated with chronic graft-versus-host disease, recurrent leukemia, AIDS, secondary cancer, organ dysfunction, and neurologic or psychological problems. Other risk factors for incomplete resumption of social activity were female sex (P = 0.002) and older age at transplantation (P = 0.001). Conclusions: More than 5 years after bone marrow transplantation, most patients were in good health (93%) and had returned to full-time work or school (89%). Recurrence of the primary disease, secondary cancer, and chronic graft versus host disease and its sequelae remain problems for some patients.

Original languageEnglish
Pages (from-to)184-192
Number of pages9
JournalAnnals of Internal Medicine
Volume126
Issue number3
Publication statusPublished - 1997

Fingerprint

Bone Marrow Transplantation
Health Status
Survivors
Graft vs Host Disease
Neoplasms
Leukemia
Acquired Immunodeficiency Syndrome
Transplantation
Bone Marrow
Tissue Donors
Transplants
Hematopoietic System
Recurrence
Histocompatibility
Lymphoproliferative Disorders
Mortality
Aplastic Anemia
Hematologic Diseases
Immune System Diseases
Homologous Transplantation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Duell, T., Van Lint, M. T., Ljungman, P., Tichclli, A., Sodé, G., Apperley, J. F., ... Kolb, H. J. (1997). Health and functional status of long-term survivors of bone marrow transplantation. Annals of Internal Medicine, 126(3), 184-192.

Health and functional status of long-term survivors of bone marrow transplantation. / Duell, Thomas; Van Lint, Maria Teresa; Ljungman, Per; Tichclli, André; Sodé, Gerard; Apperley, Jane F.; Weiss, Melanie; Cohen, Amon; Nekolla, Elke; Kolb, Hans Jochem.

In: Annals of Internal Medicine, Vol. 126, No. 3, 1997, p. 184-192.

Research output: Contribution to journalArticle

Duell, T, Van Lint, MT, Ljungman, P, Tichclli, A, Sodé, G, Apperley, JF, Weiss, M, Cohen, A, Nekolla, E & Kolb, HJ 1997, 'Health and functional status of long-term survivors of bone marrow transplantation', Annals of Internal Medicine, vol. 126, no. 3, pp. 184-192.
Duell T, Van Lint MT, Ljungman P, Tichclli A, Sodé G, Apperley JF et al. Health and functional status of long-term survivors of bone marrow transplantation. Annals of Internal Medicine. 1997;126(3):184-192.
Duell, Thomas ; Van Lint, Maria Teresa ; Ljungman, Per ; Tichclli, André ; Sodé, Gerard ; Apperley, Jane F. ; Weiss, Melanie ; Cohen, Amon ; Nekolla, Elke ; Kolb, Hans Jochem. / Health and functional status of long-term survivors of bone marrow transplantation. In: Annals of Internal Medicine. 1997 ; Vol. 126, No. 3. pp. 184-192.
@article{8e95a997443d4008aa09f10664967831,
title = "Health and functional status of long-term survivors of bone marrow transplantation",
abstract = "Background: Although many patients now survive the short term complications of bone marrow transplantation for life-threatening hematologic disease, information on the health and activity of long-term survivors is sparse. Objective: To evaluate the morbidity and mortality of patients surviving more than 5 years after allogeneic bone marrow transplantation. Design: Retrospective, multicenter study. Patients: 798 recipients of bone marrow transplants (477 adults, 321 children) from 43 European centers. Patients had received transplants before December 1985 and had survived at least 5 years. Patients had received allogeneic or syngeneic bone marrow for leukemia, lymphoma, inborn diseases of the hematopoietic and immune systems, and severe aplastic anemia. Measurements: Survival, clinical performance according to Karnofsky score (in increments of 10{\%}), and social reintegration were assessed as outcomes. Patient age and sex, primary disease and status at transplantation, histocompatibility of the donor, conditioning regimen, type of prophylaxis of graft versus-host disease, and acute and chronic graft- versus-host disease were evaluated as variables. Results: For the 55 5-year survivors, actuarial mortality was 8{\%} at 10 years and 14{\%} at 15 years. The leading causes of death were disease recurrence (21 patients), chronic graft- versus-host disease with complicating infections and lung disease (11 patients), secondary cancer (8 patients), and the acquired immunodeficiency syndrome (AIDS) (5 patients). When patients with recurrent disease were excluded, late death was associated with chronic graft-versus host disease (P = 0.001), occurrence of secondary cancer (P = 0.001), male sex of the patient (P = 0.05), and female sex of the donor (P = 0.002). Clinical performance was normal (Karnofsky score, 100{\%}) or minimally reduced (Karnofsky score, 90{\%}) in 93{\%} of patients; 89{\%} of patients resumed full-time work or school. Reduced performance status and incomplete resumption of social activity were associated with chronic graft-versus-host disease, recurrent leukemia, AIDS, secondary cancer, organ dysfunction, and neurologic or psychological problems. Other risk factors for incomplete resumption of social activity were female sex (P = 0.002) and older age at transplantation (P = 0.001). Conclusions: More than 5 years after bone marrow transplantation, most patients were in good health (93{\%}) and had returned to full-time work or school (89{\%}). Recurrence of the primary disease, secondary cancer, and chronic graft versus host disease and its sequelae remain problems for some patients.",
author = "Thomas Duell and {Van Lint}, {Maria Teresa} and Per Ljungman and Andr{\'e} Tichclli and Gerard Sod{\'e} and Apperley, {Jane F.} and Melanie Weiss and Amon Cohen and Elke Nekolla and Kolb, {Hans Jochem}",
year = "1997",
language = "English",
volume = "126",
pages = "184--192",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "3",

}

TY - JOUR

T1 - Health and functional status of long-term survivors of bone marrow transplantation

AU - Duell, Thomas

AU - Van Lint, Maria Teresa

AU - Ljungman, Per

AU - Tichclli, André

AU - Sodé, Gerard

AU - Apperley, Jane F.

AU - Weiss, Melanie

AU - Cohen, Amon

AU - Nekolla, Elke

AU - Kolb, Hans Jochem

PY - 1997

Y1 - 1997

N2 - Background: Although many patients now survive the short term complications of bone marrow transplantation for life-threatening hematologic disease, information on the health and activity of long-term survivors is sparse. Objective: To evaluate the morbidity and mortality of patients surviving more than 5 years after allogeneic bone marrow transplantation. Design: Retrospective, multicenter study. Patients: 798 recipients of bone marrow transplants (477 adults, 321 children) from 43 European centers. Patients had received transplants before December 1985 and had survived at least 5 years. Patients had received allogeneic or syngeneic bone marrow for leukemia, lymphoma, inborn diseases of the hematopoietic and immune systems, and severe aplastic anemia. Measurements: Survival, clinical performance according to Karnofsky score (in increments of 10%), and social reintegration were assessed as outcomes. Patient age and sex, primary disease and status at transplantation, histocompatibility of the donor, conditioning regimen, type of prophylaxis of graft versus-host disease, and acute and chronic graft- versus-host disease were evaluated as variables. Results: For the 55 5-year survivors, actuarial mortality was 8% at 10 years and 14% at 15 years. The leading causes of death were disease recurrence (21 patients), chronic graft- versus-host disease with complicating infections and lung disease (11 patients), secondary cancer (8 patients), and the acquired immunodeficiency syndrome (AIDS) (5 patients). When patients with recurrent disease were excluded, late death was associated with chronic graft-versus host disease (P = 0.001), occurrence of secondary cancer (P = 0.001), male sex of the patient (P = 0.05), and female sex of the donor (P = 0.002). Clinical performance was normal (Karnofsky score, 100%) or minimally reduced (Karnofsky score, 90%) in 93% of patients; 89% of patients resumed full-time work or school. Reduced performance status and incomplete resumption of social activity were associated with chronic graft-versus-host disease, recurrent leukemia, AIDS, secondary cancer, organ dysfunction, and neurologic or psychological problems. Other risk factors for incomplete resumption of social activity were female sex (P = 0.002) and older age at transplantation (P = 0.001). Conclusions: More than 5 years after bone marrow transplantation, most patients were in good health (93%) and had returned to full-time work or school (89%). Recurrence of the primary disease, secondary cancer, and chronic graft versus host disease and its sequelae remain problems for some patients.

AB - Background: Although many patients now survive the short term complications of bone marrow transplantation for life-threatening hematologic disease, information on the health and activity of long-term survivors is sparse. Objective: To evaluate the morbidity and mortality of patients surviving more than 5 years after allogeneic bone marrow transplantation. Design: Retrospective, multicenter study. Patients: 798 recipients of bone marrow transplants (477 adults, 321 children) from 43 European centers. Patients had received transplants before December 1985 and had survived at least 5 years. Patients had received allogeneic or syngeneic bone marrow for leukemia, lymphoma, inborn diseases of the hematopoietic and immune systems, and severe aplastic anemia. Measurements: Survival, clinical performance according to Karnofsky score (in increments of 10%), and social reintegration were assessed as outcomes. Patient age and sex, primary disease and status at transplantation, histocompatibility of the donor, conditioning regimen, type of prophylaxis of graft versus-host disease, and acute and chronic graft- versus-host disease were evaluated as variables. Results: For the 55 5-year survivors, actuarial mortality was 8% at 10 years and 14% at 15 years. The leading causes of death were disease recurrence (21 patients), chronic graft- versus-host disease with complicating infections and lung disease (11 patients), secondary cancer (8 patients), and the acquired immunodeficiency syndrome (AIDS) (5 patients). When patients with recurrent disease were excluded, late death was associated with chronic graft-versus host disease (P = 0.001), occurrence of secondary cancer (P = 0.001), male sex of the patient (P = 0.05), and female sex of the donor (P = 0.002). Clinical performance was normal (Karnofsky score, 100%) or minimally reduced (Karnofsky score, 90%) in 93% of patients; 89% of patients resumed full-time work or school. Reduced performance status and incomplete resumption of social activity were associated with chronic graft-versus-host disease, recurrent leukemia, AIDS, secondary cancer, organ dysfunction, and neurologic or psychological problems. Other risk factors for incomplete resumption of social activity were female sex (P = 0.002) and older age at transplantation (P = 0.001). Conclusions: More than 5 years after bone marrow transplantation, most patients were in good health (93%) and had returned to full-time work or school (89%). Recurrence of the primary disease, secondary cancer, and chronic graft versus host disease and its sequelae remain problems for some patients.

UR - http://www.scopus.com/inward/record.url?scp=0031053388&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031053388&partnerID=8YFLogxK

M3 - Article

VL - 126

SP - 184

EP - 192

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 3

ER -