Conditional and unconditional estimation of multidimensional quality of life after hematopoietic stem cell transplantation: A longitudinal follow-up of 415 patients

Abstract

Emerging literature suggests that quality of life (QOL) after bone marrow transplantation is relatively good but is accompanied in some patients by a variety of residual difficulties. The studies supporting this finding, however, have been somewhat limited in scale, scope, design, and analysis. We comprehensively measured changes in multidimensional QOL in a 4-year longitudinal follow-up of 415 adult patients who received hematopoietic stem cell transplants at Fred Hutchinson Cancer Research Center. Questionnaire packets containing 271 items were mailed annually posttransplantation to patients' homes. Standard methods of analysis yielded conditional estimates depending on compliance and survival, whereas new, likelihood-based methods generated unconditional estimates applicable to the full intent-to-treat population. Typical QOL levels generally remained high over the entire study period. Most QOL functioning significantly improved over 4 years, with the remainder showing no important decrement. Although isolated problem areas, such as sexual dissatisfaction, did emerge, the level of dysfunction for most physical and psychological scales remained below 30% of scale maxima. Broadly similar results were obtained for conditional estimation, which may contain an optimistic bias, and for unconditional estimation, which largely avoids the bias. Because concurrence was obtained between the 2 types of estimation, we conclude that most patients really do experience good levels of QOL in the 4 years after transplantation. Although some problems can be anticipated, typical patients can look forward to a QOL after transplantation that is broadly comparable to that of the normal population.

Quality of life and social integration after allogeneic hematopoietic SCT

“…Overall good HRQL among long-term survivors of allogeneic BMT is common. [4][5][6][7]24,25 However, late complications, chronic extensive GVHD or older age at BMT are considered to be negative predictors of HRQL. 2,4,23 The present analysis showed that age was associated with a worse perception of global HRQL.…”

Patients receiving HLA-haploidentical/partially matched related allo-HSCT can achieve desirable health-related QoL that is comparable to that of patients receiving HLA-identical sibling allo-HSCT

“…3,5,10,12,13,20 Several scholars indicated that use of mismatched or unrelated donors was a risk factor for cGVHD. 20 However, Teshima et al 21 only noted a tendency for increasing cGVHD with increasing HLA disparity, rather than a statistically significant correlation (P ¼ 0.05); other studies found that the occurrence of cGVHD did not differ between patients receiving ISD vs HID/PMRD HSCT, 22,23 which may be due to the usage of ATG in these studies.…”

Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients

“…Many factors predict survival outcomes after allogeneic HCT, including patient age, comorbidities, donor source, performance status, diagnoses, disease status, and carepartner support. Although several studies have investigated and described QOL after transplantation, including the trajectory of QOL risk factors for QOL impairments and interventions to improve QOL, [13][14][15][16][17][18][19][20] the association of pre-transplantation QOL with recovery and survival after allogeneic HCT has not been well described. We hypothesized that QOL measures before HCT may add to the prognostic information provided by known clinical factors among allogeneic HCT recipients.…”