Stem Cell Transplant Can Leave Long-Term Health Woes

These effects are non-life-threatening but should be monitored, experts say

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By Suzanne Rostler
HealthDay Reporter

FRIDAY, Sept. 16, 2005 (HealthDay News) -- Blood cancer patients who undergo stem cell transplantation therapy are likely to suffer more health problems 10 years down the road compared with healthy individuals who've never had this cutting-edge therapy, new research finds.

The study examined the long-term health of blood cancer survivors treated with stem cell transplant against that of healthy "controls" matched for race and age, in most cases a brother or sister.

Researchers tracked patients from before their transplant through the next 10 years, making the study one of the first to report on the long-term health of cancer survivors using this relatively new therapy. The majority of patients had been treated for leukemia or lymphoma and more than three-quarters received donor cells from a relative.

The health problems typically seen in the stem cell recipients were generally not life-threatening, the researcher point out. Rather, most can expect to have some of the problems associated with aging earlier than normal, said study author Karen L. Syrjala, director of behavioral sciences at the Fred Hutchinson Cancer Research Center in Seattle.

For instance, stem cell transplant patients were twice as likely to suffer musculoskeletal problems such as stiffness, cramping and swelling in their joints, compared to individuals without such a medical history. They also had higher rates of hepatitis C and cataract surgery.

Sexual problems were also more common, although rates of divorce, separation and the quality of marriage were similar between the two groups, according to the report in the Sept. 20 issue of the Journal of Clinical Oncology.

And while there were no differences in rates of depression and anxiety, stem cell recipients were more likely to use antidepressants and anti-anxiety medications over the long term compared with individuals who had never received a stem cell transplant. The use of other medications, such as opioids and nonsteroidal anti-inflammatory (NSAID) pain relievers, was found to be similar.

In other areas, stem cell recipients and non-recipients were indistinguishable. There were no differences in eating, smoking or exercise, the researchers report. Rates of hospitalization and outpatient visits were equal, as were rates of disorders such as asthma, diabetes, high blood pressure and high cholesterol.

Rates of osteoporosis and hypothyroidism -- disorders that both tend to be higher in cancer survivors due to the effects of chemotherapy -- were also similar between the two groups, but that may indicate poor diagnosis by doctors, the researchers said.

According to Syrjala, the finding suggests doctors need to improve on screening cancer survivors for these disorders.

"Our finding that only 4 percent of women and 2 percent of men thought they had moderate or severe bone loss is surprising, and makes us worry that bone density is not being checked in these people," she said. "If this is true, we expect that they will have more fractures, weakness and poorer long-term health than we would expect for their age."

Similarly, the finding that the cancer survivors were just as likely to use thyroid medications as individuals with no history of cancer raises concerns that some of the other symptoms reported in survivors, such as fatigue, may be the result of undetected thyroid problems, she said.

The good news is that 10 percent of stem cell recipients who suffered a relapse at some point after their transplant were in complete remission at the time of the study.

"Even when a disease like leukemia seems to return after transplant, it is possible with additional treatment to completely eradicate all signs of the disease again and for people to return to living a healthy lifestyle," Syrjala said.

With an increasing number of blood cancer patients being successfully treated with stem cell transplantation worldwide, doctors will need more information on the potential health problems of survivors, so they can monitor and treat them effectively, the researchers noted.

The results of their study are based on the medical records and personal reports of 137 cancer patients treated with hematopoietic cell transplantation (HCT). A hematopoietic stem cell is one from which all red and white blood cells develop.

Those medical outcomes were compared to the medical histories of an equal number of healthy adults (in most cases, a brother or sister of the stem cell recipient) with no history of cancer or stem cell therapy.

Syrjala said her research team will continue to monitor the health of the study patients. In the meantime, more research is needed to find ways to reach stem cell recipients and their doctors long after cancer treatment, to provide information on how to stay healthy and screen for diseases that may not normally be checked.

"As transplant becomes increasingly more common, understanding the long-term needs of these survivors will help to assure the quality of life that we want to offer them along with cure of their disease," she said.

Dr. Marshall Lichtman, executive vice president for research and medical programs at the Leukemia and Lymphoma Society, agreed. He suggested that physicians who provide primary care to patients following transplant receive information from the transplant center highlighting the problems that might develop, along with guidelines for testing.

"It is important for careful long-term follow-up of patients who have had stem cell transplantation," he said.

More information

For more about stem cell transplants, go to National Marrow Donor Program.

SOURCES: Karen L. Syrjala, Ph.D., director, behavioral sciences, Fred Hutchinson Cancer Research Center, Seattle; Marshall Lichtman, M.D., executive vice president, research and medical programs, Leukemia and Lymphoma Society, White Plains, N.Y.; Sept. 20, 2005, Journal of Clinical Oncology

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