Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia
Catherine J. Lee, Soyoung Kim, Heather R. Tecca, Stephanie Bo‐Subait, Rachel Phelan, Ruta Brazauskas, David Buchbinder, Betty K. Hamilton, Minoo Battiwalla, Navneet S. Majhail, Hillard M. Lazarus, Peter J. Shaw, David I. Marks, Mark R. Litzow, Saurabh Chhabra, Yoshihiro Inamoto, Zachariah DeFilipp, Gerhard Hildebrandt, Richard F. Olsson, Kimberly A. Kasow, Jane L. Liesveld, Seth J. Rotz, Sherif M. Badawy, Neel S. Bhatt, Jean A. Yared, Kristin Page, Martha Arellano, Michael Kent, Nosha Farhadfar, Sachiko Seo, Peiman Hematti, César O. Freytes, Alicia Rovó, Siddhartha Ganguly, Sunita Nathan, Linda J. Burns, Bronwen E. Shaw, Lori Muffly
Abstract
There is marked paucity of data regarding late effects in adolescents and young adults (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 disease-free 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 TBI was independently associated with 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 = .0006), avascular necrosis (HR, 2.49; P = .006), and diabetes mellitus (HR, 3.36; P = .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.