Predictors of Risky Health Behaviors Among Blood or Marrow Transplant (BMT) Survivors of Myeloid Malignancies - a BMT Survivor Study (BMTSS)
Authors: Balas Nora , Richman Joshua , Landier Wendy , Shrestha Sadeep , Bruxvoort Katia J , Hageman Lindsey , Meng Qingrui , Ross Elizabeth , Bosworth Alysia , Te Hok Sreng , Wong F. Lennie , Bhatia Ravi , Forman Stephen J. , Armenian Saro , Weisdorf Daniel , Bhatia Smita 
Published: December 2024

Background: BMT is used with curative treatment for patients with myeloid malignancies (acute myeloid leukemia [AML], myelodysplastic syndrome [MDS] and chronic myeloid leukemia [CML]). Despite advancements in treatment and supportive care, BMT recipients face a significant burden of late-onset health issues that elevate their risk of premature death. A recent report from BMTSS revealed that engaging in risky health behaviors (smoking, heavy alcohol consumption, and lack of exercise) is linked to a higher risk of both all-cause and non-recurrence related mortality (NRM) after adjusting for other prognosticators (Balas et al. Blood Adv, 2023). However, the characteristics of the BMT survivor population that engages in these risky health behaviors remain unknown.

Methods: We examined the prevalence and predictors of self-reported risky health behaviors among myeloid malignancy patients treated with BMT by leveraging the BMTSS. For this analysis, study participants included patients who were transplanted between 1974 and 2014 at three participating sites, with primary diagnosis of AML, MDS or CML and had survived ≥2y post-BMT. Participants (≥18y) provided information on sociodemographics, chronic health conditions (CHCs), self-rated health (SRH), and risky health behaviors. Clinical characteristics were abstracted from medical records. Using multivariable logistic regression, we examined the following factors for their association with risky health behaviors: age at survey, sex, race/ethnicity, annual household income, marital status, BMT era, body max index (BMI), primary diagnosis, pre-BMT chemotherapy and radiation, age at BMT, risk of relapse at BMT, stem cell source, BMT type, chronic graft vs. host disease (cGvHD), conditioning intensity (myeloablative [MAC]; non-myeloablative/reduced intensity [NMA]), total body irradiation (TBI), post-BMT relapse, CHCs, SRH and pain.

Results: Median age at BMT for the 1,302 participants (AML/MDS: n= 923; CML: n=379) was 41y; median time between BMT and survey was 10y; 1,130 participants had received allogeneic BMT (86.8%), 660 were male (50.7%) and 975 were non-Hispanic White (77.3%). Predictors of current smoking (n=73, 5.6%) included: heavy alcohol consumption (adjusted odds ratio [aOR]=3.7, 95%CI=1.7-8.3; ref: non-heavy drinker), separated/divorced/widowed (aOR=4.6, 95%CI=1.9-10.9 (ref: never-married), annual household income ≤$50,000 (aOR=4.0, 95%CI=2.3-7.0; ref:&gt;$50,000), and male sex (aOR=1.7, 95%CI=1.0-2.9; ref: female). Predictors of lack of exercise (n=227; 17.4%): Among the survivors reporting lack of exercise, 48.0% reported pain (n=109), necessitating a stratified analysis by pain. Among patients with pain, predictors associated with lack of exercise included: suboptimal SRH (aOR=3.6, 95%CI=2.2-5.7; ref: good SRH), annual household income ≤$50,000 (aOR=1.8, 95%CI=1.1-1.8; ref: &gt;$50,000), and obesity (aOR=2.2, 95%CI=1.1-4.1; ref: normal-weight). Among those with no pain, suboptimal SRH (aOR=3.3, 95%CI=1.7-6.2; ref: good SRH) and annual household income ≤$50,000 (aOR=1.4, 95%CI=1.0-2.4; ref: &gt;$50,000) were associated with higher odds of reporting lack of exercise. Predictors of heavy-alcohol consumption (n=70, 5.4%) included: MAC/TBI (aOR=2.9, 95%CI=1.2-6.7; ref: NMA/no TBI), smoking (aOR=2.5, 95%CI=1.4-4.1; ref: never smoker), lack of exercise (aOR=7.1, 95%CI=1.7-29.6; ref: exercise), and female sex (aOR=1.4, 95%CI=1.0-2.3; ref: male).

Conclusions: Enhancing our understanding of the risky health behaviors prevalent among BMT survivors of myeloid malignancies and their associated predictors offers a foundation for developing targeted health interventions through specialized programs, with the ultimate goal of reducing the risk of long-term mortality.