Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia

• Type of Material: Article
• Authors: Catherine J. Lee, University of Utah; Soyoung Kim, Medical College of Wisconsin; Heather R. Tecca, Medical College of Wisconsin; Stephanie Bo-Subait, Nationl Marrow Donor Program; Rachel Phelan, Medical College of Wisconsin; Ruta Brazauskas, Medical College of Wisconsin; David Buchbinder, Children's Hospital of Orange County; Betty K. Hamilton, Cleveland Clinic; Minoo Battiwalla, Sarah Cannon Bone Marrow Transplant Program; Martha Arellano, Emory University
• Language: English
• Date: 2020-03-24
• Publisher: AMER SOC HEMATOLOGY
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by The American Society of Hematology.
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2019001126
• Title of Journal or Parent Work: BLOOD ADVANCES
• Volume: 4
• Issue: 6
• Start Page: 983
• End Page: 992
• Keywords: Science & Technology; SURVIVORS; FOLLOW-UP; Life Sciences & Biomedicine; OUTCOMES; 2ND MALIGNANT NEOPLASMS; INCREASED RISK; SOLID CANCERS; MARROW TRANSPLANTATION; Hematology; BUSULFAN; CHILDREN; CHILDHOOD
• Research Categories: Biology, Cell; Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

There ismarkedpaucityofdata regarding late effects inadolescentsandyoungadults (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 diseasefree 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 TBIwas independently associatedwith 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 5 =0006), avascular necrosis (HR, 2.49; P 5 .006), and diabetes mellitus (HR, 3.36; P 5 =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.