Long-Term Follow-Up

Anniversary visit key to good health

Dr. Stephanie Lee

Dr. Stephanie Lee

Study supports need for follow-up visit

Spring 2008

At the Seattle Cancer Care Alliance, patients who undergo bone-marrow and peripheral blood stem-cell transplants are asked to return for a comprehensive evaluation after one year.

The exhaustive follow-up visit is common practice at the SCCA-through the LTFU program-but it's not a universal requirement in the medical community; many institutions in the United States and around the world that perform transplants don't do such comprehensive follow-ups.

But a Hutchinson Center study has confirmed what researchers have suspected all along: A systematic patient evaluation at one year following allogeneic hematopoietic cell transplantation is an important part of monitoring for late effects.

The study, headed by Hutchinson Center researcher Dr. Stephanie J. Lee, looked at the records of 118 adults who received transplants at the SCCA in 2005. Researchers studied patient information to document the frequency of abnormal findings and to assess the value of routine long-term follow-up assessments after transplantation.

"We wanted to answer a lot of questions," Lee said. "A lot of places don't do standardized follow-ups. How could we better help our patients? Should we be working harder to let people know how important this follow-up is? The answer is yes."

After analyzing patient data, Lee's team found a number of medical issues affecting patients that supported the need for follow-up evaluations.

"One year out (after transplant), there's usually something going on. When you put all the information together, as we did with our study, you can see there are a lot of things going on with patients," Lee said.

"Once you leave the Center, it's not over. The patient can't think it's over," she said. "And we certainly don't want people to fall off the radar screen. We want to make sure they live up to a ripe old age and not get something else that's preventable."

The bottom line: A routine comprehensive LTFU evaluation at one year is extremely useful; it detects a high frequency of medical problems requiring active intervention or adjustment of therapy.

Lee said that while the ultimate effect on health outcomes is unknown, experience suggests that all patients should be evaluated to monitor for late effects. Among the study's findings:

  • Four of 106 patients who had no prior evidence of recurrent malignancy were diagnosed with it. While difficult to tell the patients such results, it does allow for earlier treatment when a cancer is more likely to respond.

  • Nine of 31 patients who had no prior diagnosis of chronic GVHD were diagnosed with it during their LTFU visit.

  • Lack of immunity to preventable diseases was documented for a significant number of patients-95 percent required at least one additional vaccination after the LTFU boosters. Lee said the study also pointed out other important benefits of participating in the one-year follow-up.

"For patients, the single biggest worry is cancer relapse. And their faces really light up when they hear, 'your bone marrow looked fine,'" she said. "We're hoping to do more studies so we can learn how to continue to improve health beyond transplant. We have more survivors than any other institution ... and we really appreciate that survivors participate in research so we can continue to improve our success rates."