Beyond the Transplant: Long-Term Outcomes and Quality of Life in allo-HCT Patients

The risk of long-term adverse events and quality-of-life (QOL) status remains an unknown for patients who undergo allogeneic hematopoietic cell transplant (allo-HCT), especially those with nonmalignant conditions like aplastic anemia. A study conducted at the Fred Hutchinson Cancer Center sought to evaluate these outcomes.

A total of 122 aplastic anemia transplant patients were surveyed between 2015 and 2023, and researchers found that most survivors received transplants from matched related. Common late effects included sexual dysfunction, cataracts, and bone issues; however, most patients of working age were back to employment. Importantly, QOL scores were similar between patients who received matched related vs unrelated donors.

Here, Neel Bhatt, MBBS, MPH, an assistant professor of the Clinical Research Division at Fred Hutch and in the Department of Pediatrics at the University of Washington School of Medicine, discussed the study, its findings, and main takeaways for community oncologists.

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0:05 | We have 122 patients who met our study criteria. These are all pediatric adult patients with aplastic anemia. Our age range was anywhere between 1 to 67 years at the time of transplant, and the patients were a median of 50 years old at the time of the survey. The median time from transplant was 25 years, and the longest posttransplant follow-up was almost 50 years. It is great to see the follow-up of these patients this long. That is one of the strengths of our analysis.

We noticed that the patients overall had a good quality of life at this point posttransplant, even when compared with the general population. Also when we compare the quality of life between the donor types, most of the patients in our cohort had received matched related donors, about 70%, and rest of them had received unrelated or haploidentical donor.

1:18 | We found that the quality of life was equal. However, the numbers were small for the unrelated or haploidentical donor just because, in the past, we did not do those transplants. In the future, as we see this use of matched unrelated donors [and] haploidentical donors increasing, we hope to do the study again to see if these results are still the same.

Additionally, we saw that the majority of complications were cataracts, osteoporosis, osteopenia, and sexual dysfunction in the cohort. Almost 70% of the survivors were back to school or back to work full-time or part-time, so that was fantastic.

2:00 | It could be we might be seeing these results because these patients are so many years out from transplant. As a next step, we are trying to see if the results are different if we look at just patients who have been transplanted who are filling out this survey within 10 years of transplant vs 10 to 20 years, 20 to 30 years. We are going to do some additional analysis to find out if the results change. Also, we will be looking at pediatric vs adult recipients to make sure they have still a similar quality of life or if there are any differences as well.