Late Effects of Transplantation

March 30, 2015
Lisa Schulmeister, MN, RN, ACNS-BC, OCN , FAAN

Increased risk of bone fracture noted among patients aged 45-64 years.

As more is learned about the late effects of various types of cancer treatment, we’re better able to anticipate patients’ needs and improve the early detection of these late effects.

Researchers at The University of Texas MD Anderson Cancer Center analyzed data from 7620 adult patients who underwent hematopoietic stem cell transplantation from January 1997 to December 2011 and were followed-up until December 2013 (median follow-up was 85 months). Data included the cumulative incidence of fracture as well as age and gender fracture incidence, which were compared to a control population using estimated rates from the 1994 National Health Interview Survey and the 2004 National Hospital Discharge Survey.

Half (51%) of the patients underwent autologous stem cell transplantation and 49% underwent allogeneic stem cell transplantation. Most (75%) were white and 56% were male and 44% were female. The transplants were done to treat hematologic malignancies (67%), multiple myeloma (22%), and solid tumors (11%, of which 46% were breast cancers and 27% were ovarian cancers).

Fractures occurred in 602 (8%) patients overall, with 11% occurring among those who had an autologous stem cell transplantation and 5% of those who had undergone allogeneic stem cell transplantation. Fracture incidence rates after hematopoietic stem cell transplantation were significantly greater than those in the U.S. general population in almost all subgroups, and data suggest that patients aged 45-64 were at highest risk. The researchers noted that about half of the patients died before the study concluded, so long term outcome data may have been different had these patients lived longer. The take home message is that this study suggests that long term effects of hematopoietic stem cell transplantation include an increased fracture risk and older patients should be closely monitored.

Reference

Pundole XN, Barbo AG, Lin H, et al. Increased incidence of fractures in recipients of hematopoietic stem-cell transplantation.

JCO,

published online on March 16, 2015; DOI:10.1200/JCO.2014.57.8195.