Papers of the Week

Patient-reported outcomes among survivors of pediatric hematopoietic stem cell transplant (HSCT) are understudied. We compared symptom prevalence, health-related quality of life (HRQOL), and risk factors in adult survivors of childhood hematologic malignancies treated with HSCT to those treated with conventional therapy and non-cancer controls. Survivors of childhood hematologic malignancies (HSCT N=112 [70% allogeneic, 30% autologous]; conventionally-treated N=1,106) and non-cancer controls (N=242) from the St. Jude Lifetime Cohort Study completed surveys assessing 10 symptom domains, and SF-36 HRQOL summary scores. Chronic health conditions (CHCs) were validated by clinical assessment. Multivariable logistic regression reveals that compared to non-cancer controls, HSCT survivors endorsed a significantly higher symptom prevalence in sensation (OR=4.7, 95% CI=2.6-8.4), motor/movement (OR=4.3, 95% CI=1.6-11.0), pulmonary (OR=4.6, 95% CI=1.8-11.8) and memory domains (OR=4.8, 95% CI=2.5-9.2), and poorer physical HRQOL (OR=6.9, 95% CI=2.8-17.0). HSCT and conventionally-treated survivors had a similar prevalence of all symptom domains and HRQOL (P's>0.05); however, HSCT survivors had a significantly higher cumulative prevalence for specific symptoms: double vision (P=0.04), very dry eyes (P<0.0001), and trouble seeing when wearing glasses (P<0.0001). Occurrence of organ-specific CHCs, instead of transplant receipt, was significantly associated with a higher prevalence of all symptom domains (P's<0.05) in adult survivors of childhood cancer, except for pain and anxiety domains. This study found that patient-reported outcomes were equally impaired between HSCT and conventionally-treated survivors, but poorer in both groups compared to non-cancer controls. Poor patient-reported outcomes in all survivors of childhood hematologic malignancies correlated with the presence of CHCs, whether treated with conventional therapy or HSCT.