Substance Abuse and Bone Marrow Transplant

The purpose of this retrospective study is to test the hypothesis that lifetime substance abuse has an adverse impact on survival after bone marrow transplant (BMT). This study included 17 of 468 patients admitted to the Bone Marrow Transplant Unit at the Brigham and Women's Hospital in Boston, Massachusetts who were identified to have lifetime substance abuse (SA). Seventeen comparison subjects were selected from the admissions roster if they matched for disease and stage, type of transplant, pretransplant conditioning regimen, and age, but did not have SA. The medical records of all 34 patients were then reviewed by expert substance abuse clinicians for confirmation of SA and course of transplant. Survival time was calculated from the date of BMT admission to the date of last contact. Survival data were analyzed through Kaplan Meier survival curves and log rank tests for association of survival time with lifetime SA, both before and after stratification for history of cigarette smoking and type of transplant. The patients with and without SA were well matched for all clinical factors. Substance abuse or dependence was confirmed in all 17 patients, with alcohol (71%), marijuana (30%), and opiates (30%) identified as the principal substances of abuse. Survival analysis demonstrated reduced survival times for patients with SA, p = .0022. This difference persisted after stratifying for type of transplant and cigarette smoking. Trends in different survival times by type of transplant (p = .054) and by history of cigarette smoking (p = .07) were also identified. Lifetime substance abuse or dependence appears to have an adverse association with survival after bone marrow transplant when other clinical factors are equal.