Chronic Health Problems in Survivors of Hematopoietic Cell Transplants (11/10/10 issue)
The article “Documented: Chronic Health Conditions Remain a Problem for Patients Undergoing Hematopoietic Cell Transplants,” by Heather Lindsey, in the November 10 issue, discussed results from my recent study, published in Blood (2010;116;3129-3139), regarding the burden of chronic health conditions experienced by hematopoietic cell transplant (HCT) survivors. As stated, data from that study indicate that for 10-year HCT survivors, the probability of developing a severe or life-threatening chronic health condition exceeds 30 percent. The implications for follow-up care are significant, and many of these survivors are at risk for second malignancies as a result of therapeutic exposures used during treatment of their primary cancer.
Dr. Scott Rowley raised questions regarding appropriate screening for younger survivors who fall below current age cut-offs for standard cancer screening. The Children's Oncology Group has developed exposure-based guidelines for screening young HCT survivors (those treated during childhood, adolescence and young adulthood) who are at increased risk for secondary malignancies. Specifically, in response to the questions that Dr. Rowley raised, these guidelines call for initiation of breast cancer screening (with mammography and MRI) at age 25 and colonoscopy at age 35 for patients at increased risk.
The Children's Oncology Group Long-Term Follow-Up Guidelines are available for downloading in their entirety at www.survivorshipguidelines.org
SMITA BHATIA, MD, MPH
Professor and Chair
Department of Population Sciences
City of Hope National Medical Center
Associate Director, Population Research
City of Hope Comprehensive Cancer Center