Health-Risk Behaviors among Long-Term Hematopoietic Cell Transplant (HCT) Survivors: A Report from the Bone Marrow Transplant Survivor Study.
Authors: Carter Andrea , Francisco Liton , Baker K. Scott , Forman Stephen J. , Grant Marcia , Gurney James G. , Robison Leslie L. , Weisdorf Daniel , Bhatia Smita 
Published: April 2020

Abstract
Health-risk behaviors such as smoking could potentially interact with therapeutic exposures, increasing the risk of long-term sequelae, and have been understudied after HCT. The current study characterizes self-reported health-risk behaviors in 886 adult HCT survivors, who underwent HCT for hematologic malignancies or other diagnoses at City of Hope or University of Minnesota between 1974 and 1998, were 21 years (yr.) or older at HCT, and had survived two or more yr. after HCT. Stem cell donor type included autologous (n=428), related donor (n=372) and unrelated donor (n=86). Median age at HCT was 38.2 yr.; median age at survey, 46.3 yr.; and median length of follow-up, 6.5 yr.; 55% were males. Study participants completed a 255-item health questionnaire that contained items on health-risk behaviors, including current or past smoking (ever smoked at least 100 cigarettes); alcohol use (women: &gt;7 drinks/week; men: &gt;14/week); exercise (&lt;5 days/week of vigorous &gt;20-minute exercise); and having ever had a mammogram for women &gt;40 yr. at survey. Of the 886 survivors, 44% reported ever having smoked (median age at initiation 17 yr., range 8–41) and 14% reported being current smokers. Factors associated with smoking initiation included white race (RR=1.85, 95%CI, 1.3–2.7), and annual household income $20-60,000 compared with &gt;$60,000 [RR=1.4 (1.0–1.9)]. Median age at smoking cessation was 32 yr. (16–60), and factors included higher yearly household income [&gt;$60,000: RR=1.6 (1.1–2.3)], age &lt;45 yr. at HCT [RR=1.5 (1.2–1.9)], age &gt;18 yr. at smoking initiation [RR=1.58 (1.2–2.1)], and smoking rate ≤10 cigarettes /day [RR=1.54 (1.2–2.0)]. Excessive alcohol consumption was reported by 5% of the cohort, and lower income (&lt;$20,000: RR=0.13) and presence of cGVHD (RR=0.4) were associated with reduced risk. Recommended amount of exercise was reported by only 13% of the cohort. Allogeneic HCT survivors were more likely to report lower levels of exercise [RR=1.88 (1.2–2.9)]. Finally, 96.5% of women &gt;40 yr. had received a mammogram ever. Reported risk behaviors among survivors were compared to those of 311 siblings with similar age, sex, and race distributions. No differences were identified between survivors and siblings in the prevalence of smoking initiation, excessive alcohol use, or frequent exercise. However survivors were more likely to stop smoking [RR=1.38 (1.1–1.8)] when compared with siblings, and female survivors ≥40 yr. were more likely than siblings to report a mammogram [RR=3.26 (1.3–8.4)]. In conclusion, 14% of the survivors report current tobacco use, and the large majority of long-term HCT survivors report less than recommended amounts of physical activity. However, when compared with the sibling comparison group, the rates of smoking cessation are higher among survivors, and survivors are more likely to report having undergone at least one mammographic screening. These health-risk behaviors may provide targets for future interventions to minimize the prevalence of preventable health complications in this vulnerable population.