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BMT Long-term Follow-up Study

The Blood or Marrow Transplant Long-term Follow-up Study (BMT Long-term Follow-up Study) is a collaborative research effort between the City of Hope (COH) and University of Minnesota (UMN). This study began in 2000 and was initially funded by a grant from the National Cancer Institute. The original BMT Long-term Follow-up Study cohort consisted of over 2500 individuals who had received blood or marrow transplantation (BMT) at COH or UMN between 1974 and 1998. Now, with funding from the Leukemia Lymphoma Society, the BMT Long-term Follow-up Study cohort is being expanded to include about 7500 children and adults who underwent BMT at COH or UMN between 1974 and 2010, and survived at least two years. The expansion study will also enroll 1500 siblings to serve as the comparison group. The BMT Long-term Follow-up Study, assembled through the efforts of the investigators at COH and UMN, will be the largest undertaking of its kind. It will be coordinated through City of Hope, in Duarte, CA.
 
BMT is used with curative intent for many life-threatening illnesses. Over 70% of those who survive the first two years after BMT become long-term survivors. The BMT Long-term Follow-up Study examines detailed information regarding the long-term health of those treated with BMT. However, researchers have not yet followed such patients long enough to understand the very long-term issues faced by these patients. The importance of this study encompasses the long-term well-being of the transplant survivor, and the practice of the physician. For the transplant team, knowledge of late effects of therapy is critical in choosing initial therapy for patients, as well as in planning appropriate follow-up of survivors. A more thorough understanding of post-BMT complications could result in a more effective use of prevention strategies after transplant, a potential reduction in possible complications after BMT and decreased cost for patients’ care.
 

Biopathology

 
COH and UMN have collaborated in an effort to understand the long-term health of persons treated with a blood or marrow transplant. We are studying the risk of long-term side effects of BMT, and the molecular underpinnings of these complications. The Expanded BMT Long-term Follow-up Study will be collecting specimens from all patients and sibling participants to carry out these aims. The hope is to more fully understand the molecular basis of the complications so as to predict potential complications after BMT. The data will put us on the path toward being able to identify specific biomarkers and to give personalized treatment to address those effects. To that end, we will be collecting samples of saliva, cheek cells, fingernails and toenails, or blood to pinpoint and isolate relevant biomarkers.

Understanding the morphological and/or molecular structures involved will enable clinicians to perform better and targeted care to specific tumors. COH and UMN researchers will then use the information collected as part of its therapeutic arsenal to make recommendations for the treatment and follow-up of future patients treated with BMT.
 

Expanded Study

The original BMT Long-term Follow-up Study is undergoing expansion (by including patients transplanted up to 2010) and extended (with longer follow-up of the original cohort of patients) to form the Expanded BMT Long-term Follow-up Study. This study will continue to examine the health and well-being of individuals undergoing BMT, extend the length of follow-up after transplant, and, by collecting biological samples, pinpoint potential molecular markers that will allow us to dispense appropriate, timely and risk-based preventive care to help ease the late effects of therapy.
 
The Expanded Blood or Marrow Transplant Long-term Follow-up Study endeavors to:
  • Understand the long-term health issue faced by patients undergoing BMT
  • Describe the burden of morbidity borne by patients undergoing BMT and compare with age- and sex-matched siblings
  • Describe health risk behaviors and healthcare utilization by HCT survivors and compare with age- and sex-matched siblings
  • Describe risk of long-term complications in individuals undergoing BMT
  • Create a repository of DNA for future study to identify/determine who is at highest risk for long-term complications, and how best to treat these conditions.

Blood or Marrow Transplants are frequently offered to patients suffering from leukemia, lymphoma, multiple myeloma and other diseases. As research and techniques have improved, the number of patients who survive such treatments has dramatically increased such that now over 70% of patients who survive the first two years after transplant become long-term survivors. Still, BMT recipients often have an increased risk for long-term complications such as heart disease, lung problems, bone problems or other new cancers. Research has yet to fully understand these long-term problems that affect transplant patients, yet appropriate, timely and risk-based preventive care may help attenuate some late effects of such therapy.
 
Previous studies in BMT patients have been limited by a number of complicating factors:
 
  • reliance on incomplete or inadequate registry data
  • failure to examine other factors that may have affected post-HCT complications (misdiagnosis)
  • inability to track patients for extended periods of time to wholly understand complications
  • lack of biological specimens to study individual differences at the molecular level that affect risk of complications.

The Expanded BMT Long-term Follow-up Study will be the largest study of its kind. We aim to study about 7500 children and adults who have undergone BMT at City of Hope or University of Minnesota between 1974 and 2010. We will also enroll 1500 siblings to serve as a comparison group. The inclusion of siblings will allow investigators to make direct comparisons with survivors providing baseline non-BMT data that may be lacking from other sources. Additionally, the use of siblings may enable us to identify potential factors that may be associated with the development of long-term complications and understand more fully the molecular basis for the complications.
 

HealthyLiving

It is important to maintain a healthy lifestyle which includes eating healthily, being physically active and taking safety precautions throughout one’s daily life. Along with these simple guidelines (below) the following websites have useful information to help you accomplish your post-cancer goals.
 
Diet and Exercise:
Proper nutrition and exercise are important for good health
Eat a healthy diet each day:
 
  • Eat high calcium food (milk products including yogurt, cheese, and dark green vegetables (such as broccoli)
  • Eat low-fat food
  • Five or more servings of fruit and vegetables
  • High fiber food (whole grain bread, pasts, cereal, rice, etc.)
  • Choose fish, turkey, chicken, and beans; limit red meats
  • Limit fried food, high sugar foods, and candy
 
Maintain healthy weight
Exercise regularly
 
Healthy living:
Healthy habits and regular health care check-ups are important for good health
 
  • Get regular health care check-ups
  • Use sunscreen
  • Avoid second hand smoke and do not smoke or use other tobacco products
  • Avoid taking medicines that you don’t need
  • Do not drink alcohol or use illicit drugs
  • Wear seatbelt when riding or driving a car
  • Do not ride in the front seat of a car if you are less than 12 years old
  • Ride in a car seat until 40 pounds (18 kgs)
  • Use a booster seat until age 6 years old or 60 pounds (27 kgs), whichever occurs last
  • Wear a helmet, elbow and knee pads when skateboarding or rollerblading
  • Wear a helmet when riding a bike
 

Original BMT Study

BMT Study
 
City of Hope and University of Minnesota researchers initially assembled a group of ~2500 subjects who had undergone BMT between 1974 and 1998 and survived two or more years. Findings from this study helped describe the health (both physical and psychological) of individuals who had received BMT during childhood or as adults. Specifically, this study described the long-term term survival after BMT, the health of patients who had received BMT for chronic myeloid leukemia, non-Hodgkin lymphoma, acute lymphoblastic leukemia and acute myeloid leukemia. The study was also able to describe the health care utilization by long-term survivors, and their health habits. Finally, the study was able to describe the overall burden of morbidity borne by individuals receiving BMT.

Publications

 
 
Some of the publications resulting from the original BMT Long-term Follow-up Study include:
 
1. Louie A, Robison LL, Bogue M, Hyde S, Forman SJ, Bhatia S. Validation of self-reported complications by bone marrow transplantation survivors. Bone Marrow Transplant. 2000;25:1191-1196.

http://www.ncbi.nlm.nih.gov/pubmed/10849532
 
2. Baker KS, Gurney JG, Ness KK, Bhatia R, Forman SJ, Francisco L, McGlave PB, Robison LL, Snyder DS, Weisdorf DJ, Bhatia S. Late effects in survivors of chronic myeloid leukemia treated with hematopoietic cell transplantation: results from BMTSS. Blood. 2004;104:1898-1906.
 
 
3. Bhatia S, Robison LL, Francisco L, Carter A, Liu Y, Grant M, Baker KS, Fung H, Gurney JG, McGlave PB, Nademanee A, ramsay NK, Stein A, Weisdorf DJ, Forman SJ. Late Mortality in survivors of autologous hematopoietic cell transplantation: report from the BMTSS. Blood. 2005;105:4215-22.
 
 
4. Ness KK, Bhatia S, Baker KS, Francisco L, Carter A, Forman SJ, Robison LL, Rosenthal J, Gurney JG. Performance limitations and participation restrictions among childhood cancer survivors treated with hematopoietic stem cell transplantation: the BMTSS. Arch Pediatr Adolesc Med. 2005;159:706-13.
 
 
5. Gurney JG, Ness KK, Rosenthal J, Forman SJ, Bhatia D, Baker KS. Visual, auditory, sensory, and motor impairments in long-term survivors of hematopoietic stem cell transplantation performed in childhood: reports from the BMTSS. Cancer. 2006;106:1402-8.
 
 
6. Carter A, Robison LL, Francisco L, Smith D, Grant M, Baker KS, Gurney JG, McGlave PB, Weisdorf DJ, Forman SJ, Bhatia S. Prevalence of conception and pregnancy outcomes after hematopoietic cell transplantation: report from the BMTSS. Bone Marrow Transplant. 2006;37:1023-9.
 
 
7. Fraser CJ, Bhatia S, Ness K, Carter A, Francisco L, Arora M, Parker P, Forman S, Weisdorf D, Gurney JG, Baker KS. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from BMTSS. Blood. 2006;108:2867-2873.
 
 
8. Baker KS, Ness K, Steinberger J, Carter A, Francisco L, Burns LJ, Sklar C, Forman S, Weisdorf D, Gurney JG, Bhatia S. Diabetes, hypertension and cardiovascular events in survivors of hematopoietic cell transplantation: A report from the BMTSS. Blood. 2007;109:1765-1772.
 
 
9. Shankar S, Carter A, Sun CL, Francisco L, Baker KS, Gurney JG, Weisdorf DG, Forman SJ, Robison LL, Grant M, Bhatia S. Health Care Utilization by adult long-term survivors of hematopoietic cell transplant: Report from the BMTSS. Cancer Epidemiol Biomarkers Prev. 2007;16:834-839.
 
 
10. Majhail NS, Ness KK, Burns LJ, Sun CL, Carter A, Francisco L, Forman SJ, Bhatia S, Baker KS. Late Effects in Survivors of Hodgkin and non-Hodgkin lymphoma treated with autologous hematopoietic cell transplantation: a report from the BMTSS. Biol Blood Marrow Transplant. 2007;13:1153-9.
 
 
11. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG, McGlave PB, Nademanee A, O'Donnell M, Ramsay NK, Robison LL, Snyder D, Stein A, Forman SJ, Weisdorf DJ. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors. Report from the BMTSS. Blood. 2007;110:3784-3792.
 
 
12. Prasad PK, Sun CL, Baker KS, Francisco L, Forman S, Bhatia S. Healthcare utilization by adult Hispanic long-term survivors of hematopoietic stem cell transplantation: report from the BMTSS. Cancer. 2008;113:2724-33.
 
 
13. Armenian SH, Sun CL, Teh JB, Arora M, Baker KS, Francisco L, Forman SJ, Bhatia S. Ethnic differences in chronic health conditions after hematopoietic cell transplantation: a report from the BMTSS. Cancer 2010;116:4152-9.
 
 
14. Sun CL, Francisco L, Kawashima T, Leisenring W, Robison LL, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Prevalence and Predictors of Chronic Health Conditions after Hematopoietic Cell Transplantation: A report from the BMTSS. Blood. 2010;116:3129-3139.
 
 
15. Baker KS, Ness KK, Weisdorf D, Francisco L, Sun CL, Forman SJ, Bhatia S. Late effects in survivors of acute leukemia treated with hematopoietic cell transplantation: a report from the Bone Marrow Transplant Survivor Study. Leukemia. 2010; 24:2039-47.
 
 
16. Armenian S, Sun CL, Kawashima T, Arora M, Leisenring W, Sklar CA, Baker KS, Francisco L, Teh JB, Mills G, Wong FL, Rosenthal J, Diller LR, Hudson MM, Oeffinger KC, Forman SJ, Robison LL, Bhatia S. Long-term health-related outcomes in survivors of childhood cancer treated with HCT versus conventional therapy: A report from BMTSS and CCSS. Blood. 2011;118:1413-20.
 
 
17. Sun CL, Francisco L, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Adverse Psychological Outcomes in Long-term Survivors of HCT. Blood. 2011;118:4723-31.
 
 
18. Armenian SH, Sun CL, Francisco L, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Health behaviors and cancer screening practices in long-term survivors of HCT: A report from the BMTSS. Bone Marrow Transplantation. 2012;47:283-290.
 
 
19. Vanderwalde AM, Sun CL, Laddaran L, Francisco L, Armenian S, Berano-Teh J, Wong FL, Popplewell L, Somlo G, Stein AS, Nademanee A, Krishnan A, Kogut N, Forman SJ, Bhatia S. Conditional survival and cause-specific mortality after autologous hematopoietic cell transplantation for hematological malignancies. Leukemia. 2012 Nov 7. doi: 10.1038/leu.2012.311.
 
 

Contact Us

Blood or Marrow Transplant Long-term Follow-up Study City of Hope
1500 East Duarte Road
Duarte, CA 91010
 
www.BMTStudy.com
bmtstudy@coh.org
toll free: (866) 242-1356
 
Principal Investigators:
Dr. Smita Bhatia, City of Hope
Dr. Mukta Arora, University of Minnesota
 
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