Gaps in Long Term Follow up Assessment of Lymphoma Patients Following Autologous Hematopoietic Stem Cell Transplant

Background Autologous hematopoietic stem cell transplantation (HSCT) offers an effective therapeutic strategy for patients with relapsed and refractory Hodgkin and non-Hodgkin lymphoma. Given their younger age, adolescent and young adult (AYA) patients typically present with fewer comorbidities at baseline. However, due to their relatively longer lifespan, they are more susceptible to late toxicities. It is commonly believed that after the challenges of lymphoma treatment, many young survivors aspire to lead a normal lifestyle, which, combined with the stresses of young adulthood, might decrease their compliance with follow-up. This emphasizes the critical need for dedicated survivorship care. Methods A retrospective analysis was conducted on 253 lymphoma patients who underwent autologous HSCT between 2014 and 2021. Per our policy, post-transplant echocardiogram was only completed in patients at risk and in symptomatic patients. Post-transplant follow-up adherence and outcomes were evaluated across age groups. Results Baseline characteristics of our patients are provided in Table 1. Contrary to our initial hypothesis, AYA patients demonstrated relatively longer median follow-up than older patients. AYA patients had better long-term survival than the patients from the older groups (Table 2). The oldest age group displayed higher rate of cardiac dysfunction, consistently with age-related comorbidities in general population. The rate of secondary malignancies was higher in older papulation, likely due to combination of higher susceptibility to secondary therapy-related tumorigenesis and age-related prevalence of malignancies in older individuals. The AYA patient group notably exhibited a higher number of new/worsening depression and anxiety cases, potentially influenced by the psychological impact of cancer diagnosis, treatment-related social isolation and financial challenges (Table 3). Regrettably, we identified that a significant number of patients lacked documented psychosocial assessments (Figure 1). Conclusion Our findings highlight the unique challenges faced by different age groups after autologous HSCT, especially the pronounced psychological issues in AYA patients. AYA patients demonstrate commendable compliance with follow-up, potentially enabling to achieve comprehensive post-transplant assessments for a significant proportion of this demographic. Despite this, the gaps identified in our data, notably the absence of consistent psychosocial assessments, have driven us to change our practices. Based on our results, there is a need to establish comprehensive psychosocial assessments for transplant survivors, ensuring a holistic approach to post-transplant care and improved patient outcomes. Potential approach to address this is actively integrating templates for the assessment of late toxicities into electronic medical records.