Post‐transplantation employment status of adult survivors of childhood allogeneic hematopoietic cell transplant: A report from the Center for International Blood and Marrow Transplant Research (CIBMTR)

Background Data are scarce regarding employment outcomes of survivors of childhood allogeneic hematopoietic cell transplantation (alloHCT) and the factors that affect their employment status. Methods By using the Center for International Blood and Marrow Transplant Research database, the authors studied employment outcomes of ≥1‐year survivors of childhood alloHCT who were age ≥18 years at their most recent assessment (year of transplantation, 1985‐2010). Employment status was assessed at their attained ages (ages 18‐22, 23‐27, and 28‐32 years) and according to transplantation center (TC) location (United States or International). A multivariable analysis assessing the factors that affected employed status (full‐time/part‐time work or student) was performed. Results Unemployment rates among 2844 survivors were persistently high at all attained ages (United States TCs: ages 18‐22 [14%], 23‐27 [15%], and 28‐32 [13%] years; International TCs: ages 18‐22 [56%], 23‐27 [53%], and 28‐32 [68%] years). The factors associated a with higher likelihood of employment included: older age at alloHCT (ages 5‐9‐years: hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.65‐2.6; ages 10‐14 years: HR, 4.43; 95% CI, 3.58‐5.47; ages 15‐18‐years: HR, 7.13; 95% CI, 5.72‐8.88), myeloablative conditioning without total body irradiation (TBI) (HR, 1.56; 95% CI, 1.38‐1.77), reduced‐intensity conditioning with TBI (HR, 1.47; 95% CI, 1.19‐1.8) or without TBI (HR, 2.51; 95% CI, 2.15‐2.92), and US‐based TC (HR, 1.84; 95% CI, 1.62‐2.08). Conclusions Young adult survivors of childhood alloHCT have high unemployment rates at all studied attained ages after HCT. Future efforts should be directed toward understanding the causes of unemployment their and relation to quality of life using patient‐reported outcome measures. Employment outcomes among survivors of childhood allogeneic hematopoietic cell transplantation are unknown. Findings from this large, multi‐institutional, and multinational study, which includes 2844 patients, indicate that survivors of childhood allogeneic transplantation have persistently high unemployment rates at all studied attained ages after transplantation (range, 18‐32 years).