Total late effect burden in long-term lymphoma survivors after high-dose therapy with autologous stem-cell transplant and its effect on health-related quality of life
Knut Smeland,
Harald Holte,
Unn-Merete Fagerli,
Hanne Bersvendsen,
Marianne J. Hjermstad,
Jon H. Loge,
Klaus Murbrach,
Marianne D. Linnsund,
Oystein Fluge,
Jo S. Stenehjem,
May B. Lund,
Stein Kvaloy,
Cecilie E. Kiserud
Affiliations
Knut Smeland
National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo
Harald Holte
Department of Oncology, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for B cell malignancies, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo
Unn-Merete Fagerli
Department of Oncology, St. Olavs Hospital, Trondheim, Norway; Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim
Hanne Bersvendsen
Department of Oncology, University Hospital of North Norway, Tromso
Marianne J. Hjermstad
Regional Advisory Unit for Palliative Care and European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
Jon H. Loge
Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo
Klaus Murbrach
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo
Marianne D. Linnsund
Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lorenskog
Oystein Fluge
Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen
Jo S. Stenehjem
Department of Research, Cancer Registry of Norway, Oslo
May B. Lund
Department of Respiratory Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo
Stein Kvaloy
National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo
Cecilie E. Kiserud
National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo
Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDT-ASCT) are at risk of several late effects, which might impair their health-related quality of life (HRQoL). We assessed the total late effect burden in this population, and how it affects HRQoL. All lymphoma survivors treated with HDT-ASCT as adults in Norway between 1987 and 2008 were identified, and 271 (68%) attended both a comprehensive clinical assessment and completed a questionnaire. Severity of 45 conditions in 12 organ-system categories were graded as mild, moderate, severe or life-threatening, according to a modified version of CTCAEv4.03. At a median of 8 years after HDT-ASCT, 98% of survivors had at least one moderate or more severe late effect and 56% had severe or life-threatening late effects. Fourteen percent had low, 39% medium and 47% high late effect burden, defined as having moderate or more severe late effects in 0-1, 2-3 and >3 organsystems, respectively. Female sex, increasing age, B-symptoms at diagnosis and >1 treatment line prior to HDT-ASCT were independently associated with having high late effect burden. The survivors had significantly poorer physical and mental HRQoL assessed by the Short Form-36 compared to age- and sex-matched controls. The prevalence of poor physical and mental HRQoL increased with higher late effect burden (both P<0.001), and the low burden group had better physical HRQoL than controls (P<0.001). In conclusion, lymphoma survivors after HDT-ASCT have impaired HRQoL, seemingly driven by a high late effect burden. This highlights the importance of prevention, regular assessments for early detection and treatment of late effects and modifiable risk factors.
