Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS)
Long-term health-related outcomes in survivors of childhood cancer treated with HSCT versus conventional therapy: a report from the Bone Marrow Transplant Survivor Study (BMTSS) and Childhood Cancer Survivor Study (CCSS)
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DOI：
10.1182/blood-2011-01-331835
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发表时间：
2011-08-04
期刊：
影响因子：
20.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Armenian, Saro H.;Sun, Can-Lan;Bhatia, Smita
HSCT越来越多地被用作血液恶性肿瘤儿童的治疗选择。虽然生存率有所提高，但HSCT手术的长期发病率尚不清楚。我们比较了接受HSCT治疗的癌症儿童与接受常规治疗的幸存者以及兄弟姐妹对照的慢性健康状况和不良健康状况的风险。HSCT存活者来自BMTSS（N = 145），而常规治疗的存活者（N = 7207）和同胞（N = 4020）来自CCSS。使用CTCAEv3.0对自我报告的慢性疾病进行分级。59%的HSCT幸存者报告了≥ 2种疾病，25.5%报告了严重/危及生命的疾病。HSCT存活者比同胞对照组更可能有严重/危及生命（相对危险度[RR] = 8.1，P <0.01）和2个或更多（RR = 5.7，P <0.01）条件，以及功能障碍（RR = 7.7，P <0.01）和活动受限（RR = 6.3，P <0.01）。更重要的是，与CCSS幸存者相比，BMTSS幸存者表现出显著升高的风险（严重/危及生命的情况：RR = 3.9，P <0.01;多种情况：RR = 2.6，P <0.01;功能障碍：RR = 3.5，P <0.01;活动受限：RR = 5.8，P <0.01）。无关供体HSCT受者的风险最大。儿童HSCT幸存者不仅与非癌症人群相比，而且与常规治疗的癌症患者相比，其发病率明显更高，这为密切监测这一高危人群提供了证据。（血。2011; 118（5）：1413-1420）
HSCT is being increasingly offered as a curative option for children with hematologic malignancies. Although survival has improved, the long-term morbidity ascribed to the HSCT procedure is not known. We compared the risk of chronic health conditions and adverse health among children with cancer treated with HSCT with survivors treated conventionally, as well as with sibling controls. HSCT survivors were drawn from BMTSS (N = 145), whereas conventionally treated survivors (N = 7207) and siblings (N = 4020) were drawn from CCSS. Self-reported chronic conditions were graded with CTCAEv3.0. Fifty-nine percent of HSCT survivors reported >= 2 conditions, and 25.5% reported severe/life-threatening conditions. HSCT survivors were more likely than sibling controls to have severe/life-threatening (relative risk [RR] = 8.1, P < .01) and 2 or more (RR = 5.7, P < .01) conditions, as well as functional impairment (RR = 7.7, P < .01) and activity limitation (RR = 6.3, P < .01). More importantly, compared with CCSS survivors, BMTSS survivors demonstrated significantly elevated risks (severe/life-threatening conditions: RR = 3.9, P < .01; multiple conditions: RR = 2.6, P < .01; functional impairment: RR = 3.5, P < .01; activity limitation: RR = 5.8, P < .01). Unrelated donor HSCT recipients were at greatest risk. Childhood HSCT survivors carry a significantly greater burden of morbidity not only compared with noncancer populations but also compared with conventionally treated cancer patients, providing evidence for close monitoring of this high-risk population. (Blood. 2011; 118(5): 1413-1420)