Long-term health outcomes in older recipients of blood or marrow transplantation: a report from the BMTSS

ABSTRACT: Little is known about the long-term health and well-being of older (≥60 years) patients who received blood or marrow transplant (BMT), a growing population at risk for late-occurring morbidity and mortality. This study included ≥2-year survivors (N=1581) who underwent BMT between 1990 and 2014 at age ≥60 years. Severe/life-threatening and fatal chronic health conditions were identified using Common Terminology Criteria for Adverse Events. Multivariable regression analysis compared the risk of severe/life-threatening health conditions and health status between survivors and 594 age-matched sibling controls. Standardized mortality ratios (SMRs) and, for subsequent malignant neoplasms, standardized incidence ratios (SIRs) were calculated and compared with the general population. The prevalence of severe/life-threatening conditions was 72% in survivors of BMT vs 51% in siblings (P< .001), yielding 2.9-fold higher odds of severe/life-threatening conditions (95% confidence interval [CI], 2.2-3.7) among the survivors. Survivors were more likely to report poor general health (odds ratio [OR], 4.1 [95%CI, 2.8-6.0]), functional impairment (OR, 3.2 [95%CI, 2.5-4.0]), activity limitation (OR, 3.1 [95%CI, 2.4-3.9]), and frailty (OR, 3.5 [95% CI, 2.1-6.0]). Among survivors, the overall SMR was 5.3 (95%CI, 5.0-5.6). There was an especially high risk of infection-related mortality (SMR=35.2 [95%CI, 30.3-40.6]). Survivors had a 3.8-fold risk of subsequent neoplasms (95%CI, 3.5-4.2) relative to the general population, with incidence rates highest for Hodgkin lymphoma (SIR=18.5 [95%CI, 7.4-37.5]) and melanoma (SIR=7.4 [95%CI, 5.1-10.2]). Older recipients of BMT have a high burden of severe/life-threatening conditions and poor health status compared with sibling controls, contributing to increased relative risk of premature mortality. These findings emphasize the ongoing health care burden of survivors of BMT, particularly in this older population.