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Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia. Blood Adv 2020 03 24;4(6):983-992

Date

03/14/2020

Pubmed ID

32168378

Pubmed Central ID

PMC7094022

DOI

10.1182/bloodadvances.2019001126

Scopus ID

2-s2.0-85082533373   8 Citations

Abstract

There is marked paucity of data regarding late effects in adolescents and young adults (AYAs) who undergo myeloablative conditioning (MAC) allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). We evaluated late effects and survival in 826 1-year disease-free survivors of MAC HCT for AYA AML, with an additional focus on comparing late effects based upon MAC type (total body irradiation [TBI] vs high-dose chemotherapy only). The estimated 10-year cumulative incidence of subsequent neoplasms was 4% (95% confidence interval [CI], 2%-6%); 10-year cumulative incidence of nonmalignant late effects included gonadal dysfunction (10%; 95% CI, 8%-13%), cataracts (10%; 95% CI, 7%-13%), avascular necrosis (8%; 95% CI, 5%-10%), diabetes mellitus (5%; 95% CI, 3%-7%), and hypothyroidism (3%; 95% CI, 2%-5%). Receipt of TBI was independently associated with a higher risk of cataracts only (hazard ratio [HR], 4.98; P < .0001) whereas chronic graft-versus-host disease (cGVHD) was associated with an increased risk of cataracts (HR, 3.22; P = .0006), avascular necrosis (HR, 2.49; P = .006), and diabetes mellitus (HR, 3.36; P = .03). Estimated 10-year overall survival and leukemia-free survival were 73% and 70%, respectively, and did not differ on the basis of conditioning type. In conclusion, late effects among survivors of MAC HCT for AYA AML are frequent and are more closely linked to cGVHD than type of conditioning.

Author List

Lee CJ, Kim S, Tecca HR, Bo-Subait S, Phelan R, Brazauskas R, Buchbinder D, Hamilton BK, Battiwalla M, Majhail NS, Lazarus HM, Shaw PJ, Marks DI, Litzow MR, Chhabra S, Inamoto Y, DeFilipp Z, Hildebrandt GC, Olsson RF, Kasow KA, Liesveld JL, Rotz SJ, Badawy SM, Bhatt NS, Yared JA, Page KM, Arellano ML, Kent M, Farhadfar N, Seo S, Hematti P, Freytes CO, Rovó A, Ganguly S, Nathan S, Burns L, Shaw BE, Muffly LS

Authors

Ruta Brazauskas PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Saurabh Chhabra MD Associate Professor in the Medicine department at Medical College of Wisconsin
Soyoung Kim PhD Assistant Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Kristin Page MD, MHS, MEd Associate Professor in the Pediatrics department at Medical College of Wisconsin
Rachel A. Phelan MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
Recurrence
Transplantation Conditioning
Young Adult