Late complications and quality of life assessment for survivors receiving allogeneic hematopoietic stem cell transplantation

Abstract

Purpose

The survival rates of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) have improved. However, HSCT can induce significant long-term complications. Therefore, we investigated the late complications and risk factors for quality of life (QOL) post-HSCT.

Methods

We retrospectively analyzed 67 adult survivors over 2 years after HSCT between 2015 and 2018 at Ulsan University Hospital, Ulsan, Korea. The survey data including FACT-BMT, Hospital Anxiety and Depression Scale, and NCCN Distress Thermometer were collected as patient-reported outcomes using a tablet PC during a routine practice of survivorship clinic.

Results

The median age was 46 years. The most common symptom was fatigue (80.6%). Younger age (< 60 years), acute lymphoblastic leukemia (ALL), chronic graft-versus-host disease (GVHD), and immunosuppressant use were significantly associated with worse QOL and depression. Additionally, younger survivors (< 60 years) showed significantly more fatigue and anxiety compared with elderly survivors (≥ 60 years). Female sex was significantly associated with lower physical well-being and higher distress than male sex.

Conclusion

Younger patients (< 60 years), female, ALL, chronic GVHD, and continuous immunosuppressant use were significant risk factors for worse QOL and depression. Hence, creating a more active survivorship care plan after HSCT, specifically for these patients, is required.

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Fig. 1

Abbreviations

HSCT:

Allogeneic hematopoietic stem cell transplantation

GVHD:

Graft-versus-host disease

QOL:

Quality of life

FACT-BMT:

Functional Assessment of Cancer Therapy-Bone Marrow Transplantation

BMTS:

Bone Marrow Transplantation Subscale

PWB:

Physical well-being

SFWB:

Social/family well-being

EWB:

Emotional well-being

FWB:

Functional well-being

HADS:

Hospital Anxiety and Depression Scale

HADS-A:

HADS-anxiety

HADS-D:

HADS-depression

NCCN DT:

National Comprehensive Cancer Network’s Distress Thermometer

BPI:

Brief Pain Inventory

AML:

Acute myeloid leukemia

ALL:

Acute lymphoblastic leukemia

AA:

Aplastic anemia

MDS:

Myelodysplastic syndrome

RIC:

Reduced intensity conditioning

MAC:

Myeloablative conditioning

ATG:

Anti-thymocyte globulin

TOI:

Total Outcome Index

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Funding

This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2017R1C1B5015107), and it was also supported by the Ulsan University Hospital Research Grant (UUH-2019-06).

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Contributions

Yunsuk Choi, Jaekyoung Cheon, Jae-Cheol Jo, SuJin Koh, and Young Ju Min contributed to the study conception and design. Patient management and data collection were performed by Jaekyoung Cheon, Yoo Jin Lee, Jae-Cheol Jo, Kukju Kweon, Sang-Hyuk Park, Sin-hye Lee, and Hyo-jin Kim. Data analysis was performed by Yunsuk Choi and Jaekyoung Cheon. The first draft of the manuscript was written by Yunsuk Choi and Jaekyoung Cheon. All authors reviewed the manuscript and contributed to the editing of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yunsuk Choi.

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Cheon, J., Lee, Y.J., Jo, J. et al. Late complications and quality of life assessment for survivors receiving allogeneic hematopoietic stem cell transplantation. Support Care Cancer (2020). https://doi.org/10.1007/s00520-020-05572-0

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Keywords

  • Allogeneic hematopoietic cell transplantation
  • Late complications
  • Quality of life
  • FACT-BMT
  • Fatigue
  • Hospital Anxiety and Depression Scale