Burden of Long-Term Morbidity Borne by Survivors of Acute Myeloid Leukemia Treated with Blood or Marrow Transplantation: The Results of the BMT Survivor Study

Saro H. Armenian, Yanjun Chen, Lindsay Hageman, Jessica Wu, Wendy Landier, Alysia Bosworth, Liton Francisco, Elizabeth Schlichting, Ravi Bhatia, Donna Salzman, F. Lennie Wong, Daniel J. Weisdorf, Stephen J. Forman, Mukta Arora, Smita Bhatia

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


PURPOSE: Blood or marrow transplantation (BMT) is an integral part of consolidation and/or salvage therapy for patients with acute myeloid leukemia (AML). With the growing population of AML survivors, there is a need to understand the quality of their survival.

MATERIALS AND METHODS: This multisite study included 1,369 2-year survivors who underwent BMT for AML between 1974 and 2014 at age ≥ 21 years and 1,310 siblings. Using Common Terminology Criteria for Adverse Events, severe/life-threatening and fatal chronic health conditions were identified. Multivariable regression analysis was used to compare the risk of severe/life-threatening conditions and health status between survivors and siblings, and to identify risk factors for health conditions among BMT survivors.

RESULTS: The prevalence of severe/life-threatening conditions was 54.9% in BMT survivors compared with 28.5% in siblings ( P < .001), yielding 3.8-fold higher odds of severe/life-threatening conditions (95% CI, 3.1 to 4.7) among the BMT survivors. The most prevalent conditions included subsequent neoplasms, diabetes, cataracts, venous thromboembolism, and joint replacement. Survivors were more likely to report poor general health (odds ratio [OR], 3.8; 95% CI, 2.8 to 5.1), activity limitation (OR, 3.7; 95% CI, 3.0 to 4.5), and functional impairment (OR, 2.9; 95% CI, 2.3 to 3.6). Among BMT recipients, the 20-year cumulative incidence of severe/life-threatening/fatal conditions was 68%. History of chronic graft-versus-host disease was associated with a higher risk of pulmonary disease (hazard ratio [HR], 3.1; 95% CI, 1.0 to 9.3), cataract (HR, 2.6; 95% CI, 1.4 to 3.8), and venous thromboembolism (HR, 2.3; 95% CI, 1.3 to 4.7). Relapse-related mortality (RRM) plateaued at 30%, whereas non-RRM increased to 50% at 30 years.

CONCLUSION: The burden of severe/life-threatening conditions is substantially higher in BMT recipients when compared with an unaffected comparison group, contributing to an increasing incidence of non-RRM over time. Chronic graft-versus-host disease was an important risk factor for severe/life-threatening/fatal conditions among BMT recipients, informing the need for close monitoring to anticipate and manage morbidity.

Original languageEnglish (US)
Pages (from-to)3278-3288
Number of pages11
JournalJournal of Clinical Oncology
Issue number28
StatePublished - Oct 1 2022

Bibliographical note

Publisher Copyright:
© American Society of Clinical Oncology.


  • Adult
  • Bone Marrow
  • Bone Marrow Transplantation/adverse effects
  • Chronic Disease
  • Graft vs Host Disease/epidemiology
  • Humans
  • Leukemia, Myeloid, Acute/complications
  • Morbidity
  • Survivors
  • Venous Thromboembolism/etiology
  • Young Adult

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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