A population-based study of data from the Center for International Blood and Marrow Transplant Research identified the occurrence of malignant and nonmalignant late effects, long-term survival, and risk factors for late effects and mortality in adolescent and young adult survivors of acute myeloid leukemia (AML) who underwent hematopoietic cell transplantation (HCT; Blood Adv. 2020;4(6):983–992). 

According to Catherine J. Lee, MD, Utah Blood and Marrow Transplant Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, and colleagues, upwards of 50% of adolescents and young adults with high-risk AML end up as long-term survivors after undergoing allogeneic HCT (allo-HCT). Thus, there is a need to understand the late effects and survivorship issues in this population.

A total of 826 patients (aged 15-39 years) with AML who underwent their first HCT from a matched related or unrelated donor between 2000 and 2014 and remained disease free for at least 12 months after HCT were included in the study.

HCT conditioning with myeloablative total body irradiation (TBI; ≥500 cGy single dose or ≥800 cGy fractionated) or myeloablative doses of chemotherapy-only regimens were administered to all patients. The majority of patients given TBI received doses ≥1200 cGy, and the most frequently used myeloablative chemotherapy regimen was busulfan with cyclophosphamide.

Follow-up lasted for a median of 77 months (range, 12-194 months), and 36% of all patients had grade 2 to 4 acute graft-versus-host disease (aGVHD). Among recipients of TBI or nonTBI–based conditioning, 9% of patients had grade 3 to 4 aGVHD.

Meanwhile, chronic GVHD (cGVHD) occurred in 55% of all patients, and extensive cGVHD was documented in 45% of TBI recipients and 44% of patients given nonTBI–based conditioning.

As of the date of analysis, 177 (21%) deaths had occurred in the total population, with primary disease representing the most common cause for death across all groups.

 “Systematic ascertainment of late effects in [adolescents and young adults] is critically necessary for developing [adolescent and young adult]-focused survivorship guidelines and care plans, as has been done for survivors of childhood cancers,” Dr Lee and colleagues concluded.

“The HCT community is poised to conduct the studies that will further the understanding of late complications in [adolescents and young adults] and improve the care of this important population of cancer survivors,” they added.—Alexis Hyams