Long-term Health Outcomes in Older Blood or Marrow Transplantation Recipients: A Report from the BMTSS

Little is known about the long-term health and well-being of older (>60 years) blood or marrow transplantation (BMT) patients, a growing population at risk for late-occurring morbidity and mortality. This study included 1,581 >2-year survivors who underwent BMT between 1990-2014 at age ≥60 years. Severe/life-threatening and fatal chronic health conditions were identified using Common Terminology Criteria for Adverse Events. Multivariable regression analysis compared the risk of severe/life-threatening health conditions and health status between survivors and 594 age-matched sibling controls. Standardized mortality ratios (SMRs), and for subsequent malignant neoplasms, standardized incidence ratios (SIRs), were calculated and compared with the general population. The prevalence of severe/life-threatening conditions was 72% in BMT survivors vs 51% in siblings (P<.001), yielding 2.9-fold higher odds of severe/life-threatening conditions (95%CI 2.2-3.7) among the survivors. Survivors were more likely to report poor general health (OR 4.1, 95%CI 2.8-6.0), functional impairment (OR=3.2, 95%CI 2.5-4.0), activity limitation (OR=3.1, 95%CI 2.4-3.9), and frailty (OR=3.5, 95%CI 2.1-6.0). Among survivors, the overall SMR was 5.3 (95%CI 5.0-5.6). There was an especially high risk of infection-related mortality (SMR=35.2, 95%CI 30.3-40.6). Survivors had a 3.8-fold risk of subsequent neoplasms (95%CI 3.5-4.2) relative to the general population, with incidence rates highest for Hodgkin lymphoma (SIR=18.5, 95%CI 7.4-37.5) and melanoma (SIR=7.4, 95%CI 5.1-10.2). Older BMT recipients have a high burden of severe/life-threatening conditions and poor health status compared to sibling controls, contributing to increased relative risk of premature mortality. These findings emphasize the ongoing healthcare burden of BMT survivors, particularly in this older population.