Quality of Life and Comorbidities of Long-Term Survivors of Allogeneic Hematopoietic Cell Transplant Versus Their Siblings.

Survivors of allogeneic hematopoietic cell transplantation (allo-HCT) are known to be at risk of late toxicities. The spectrum of late toxicities may be impacted by changing allo-HCT practices: In contemporary allo-HCT practice, conditioning with high-dose total body irradiation is infrequent, the incidence of chronic GVHD is declining, and older adults receive allo-HCT more frequently. Few studies have examined the burden of comorbidities and the quality of life (QoL) of recent long-term survivors of allo-HCT, and even fewer have included a biological sibling control group for comparison. We set out to quantify and compare the burden of comorbidities and the QoL of a largely contemporary group of survivors of allo-HCT versus their biological siblings. We further aimed to understand the association of transplant-related variables, demographic variables, and comorbidities, with QoL amongst recipients. We conducted a cross-sectional study comparing QoL and comorbidity burden between allo-HCT recipients and their biological siblings. In addition, we built multivariable models to understand predictors of physical health (PH) and mental health (MH)-related QoL amongst recipients. Recipients without active chronic GVHD or relapse were enrolled at 1 of 2 survivorship clinics alongside their siblings. We used PROMIS Global Health to assess QoL and the post-transplant multimorbidity index to evaluate comorbidities. In total, 391 recipients were enrolled. Of these, 106 recipients had a total of 154 siblings enrolled for comparison. The 106 recipients experienced significantly more comorbidities versus their siblings: 3 or more comorbidities were observed in 51.9% of recipients versus 33.1% of siblings (P = .002), while at least 1 severe comorbidity was observed in 24.5% versus 13.0%, respectively (P = .02). In spite of this, PH and MH-related QoL of recipients was similar to that of siblings: PH QoL median T-score 49.9 (IQR 45.8 to 57.4) versus 50.7 (IQR 46.3 to 54.4), respectively (P = .77), and MH QoL median T-score 50.9 (IQR 44.8 to 54.6) versus 51.6 (IQR 45.3 to 55.1), respectively (P = .58). Social functioning was rated as very good or excellent by 65.1% of recipients versus 68.6% of siblings (P = .33). Amongst the entire cohort of 391 recipients, the number of comorbidities was strongly associated with MH and PH-related QoL as well as social functioning, whereas transplant-related variables such as prior cGVHD, receipt of low dose TBI, graft and donor type, were not. Survivors of allo-HCT continue to experience excess comorbidities versus their biological siblings. Despite this, survivors enjoy QoL and social functioning that are comparable to their siblings and general population norms. Amongst survivors, the number of comorbidities is strongly associated with QoL and social functioning while transplant-related variables are not.