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

Abstract

Lymphoma survivors after high-dose therapy with autologous stem-cell transplant (HDTASCT) are at risk of several late effects (LEs), which might impair their health-related quality of life (HRQoL). We assessed the total LE 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 median eight years after HDT-ASCT, 98% of survivors had at least one moderate or more severe LE and 56% had severe or life-threatening LE(s). Fourteen percent had low, 39% medium and 47% high LE burden, defined as having moderate or more severe LE(s) in 0-1, 2-3 and >3 organ-systems, respectively. Female sex, increasing age, B-symptoms at diagnosis and >1 treatment line prior to HDT-ASCT were independently associated with having high LE burden. The survivors had significantly poorer physical and mental HRQoL assessed by SF-36 compared to age- and sex-matched controls. The prevalence of poor physical and mental HRQoL increased with higher LE burden (both p<.001), and the low burden group had better physical HRQoL than controls (p<.001). In conclusion, lymphoma survivors after HDT-ASCT have impaired HRQoL, seemingly driven by a high LE burden. This highlights the importance of prevention, regular assessments for early detection and treatment of LEs and modifiable risk-factors.