Biobehavioral influences on recovery following hematopoietic stem cell transplantation

Abstract

Hematopoietic stem cell transplantation (HSCT) is a rigorous therapy that carries significant risk of morbidity and mortality to individuals with hematologic malignancies undergoing this treatment. While relationships between psychosocial factors, immune function, and clinical outcomes have been documented in other cancer populations, similar studies of cancer patients undergoing HSCT have not yet been conducted. The clinical significance of these relationships may be particularly salient in this population given the critical role of a timely immune recovery and optimal immune regulation in preventing infections, mitigating risk for graft-versus-host disease, and eliminating malignant cells, thereby reducing morbidity and mortality. Evidence for the potential role of biobehavioral processes following HSCT is reviewed, mechanisms by which psychosocial factors may influence immune processes relevant to post-transplant outcomes are discussed, and a framework to ground future psychoneuroimmunology (PNI) research in this area is provided. The review suggests that the recovery period following HSCT may provide a “window of opportunity” during which interventions targeting stress-related behavioral factors can influence the survival, health, and well-being of HSCT recipients.

Patient-Reported Outcomes and Socioeconomic Status as Predictors of Clinical Outcomes after Hematopoietic Stem Cell Transplantation: A Study from the Blood and Marrow Transplant Clinical Trials Network 0902 Trial

“…In other studies, social disparities were found to contribute additional independent risk for people with cancer [4,7,8,32–35], with patients of lower SES at risk of increased morbidity and mortality [36–42]. In the HCT setting, low SES, independent of race, has a negative impact on unrelated and related donor outcomes, including worse OS and higher transplant-related mortality (TRM) [14,43].…”

“…In contrast to other cancer populations, there is minimal published research investigating more proximal clinical events or immunologic determinants to suggest candidate biobehavioral mechanisms that might explain this relationship [7,8]. Lower levels of optimism and increased anxiety, depression, and post-traumatic symptoms in the peri-transplant period are associated with impaired white blood cell recovery post-HCT [9–11].…”

Host interleukin 6 production regulates inflammation but not tryptophan metabolism in the brain during murine GVHD

“…Cognitive and behavioral alterations are common after allogeneic HSCT and are often associated with coexistent GVHD (44,45). These not infrequently occur in patients that have otherwise been cured of their disease and can profoundly affect quality of life in an adverse manner.…”

Biobehavioral approaches to cancer progression and survival: Mechanisms and interventions.

“…These might include markers of tumor invasion, metastasis, and inflammation, particularly those factors known to be associated with progression of the specific type of tumor being investigated. Research targeting effects of biobehavioral factors and interventions on outcomes of clinical importance is needed as well, for example, on recovery from hematopoietic stem cell transplant (Costanzo, Juckett, & Coe, 2013), recovery from surgery (Neeman & Ben-Eliyahu, 2013), augmentation of immunotherapy or targeted therapies, and others.…”