Determinants of functional performance in long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD)

Abstract

This study examined factors accounting for functional performance limitations in 100 long-term survivors of allogeneic hematopoietic stem cell transplantation with chronic graft-versus-host disease (cGVHD). Functional performance, measured by the SF-36 physical component summary score, was substantially lower (mean ¼ 36.8±10.7) than the US population norm of 50 (Po0.001). The most severe decrements were in physical function (mean ¼ 38.8 ± 10.9) and physical role function (mean ¼ 37.88±11.88); 68% of respondents exceeded the five-point threshold of minimum clinically important difference below the norm on these subscales. Controlling for age and gender, six variables explained 56% of the variance in functional performance: time since cGVHD diagnosis, cGVHD severity, intensity of immunosuppression, comorbidity, functional capacity (distance walked in 2 min, grip strength, and range of motion), and cGVHD symptom bother (F ¼ 11.26; Po0.001). Significant independent predictors of impaired performance were intensive systemic immunosuppression, reduced capacity for ambulation, and greater cGVHD symptom bother (Po0.05). Symptom bother had a direct effect on functional performance, as well as an indirect effect partially mediated by functional capacity (Sobel test, P ¼ 0.004). Results suggest two possible mechanisms underlying impaired functional performance in survivors with cGVHD and underscore the importance of testing interventions to enhance functional capacity and reduce symptom bother.

Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease

“…The functional impact of ScGVHD in our study reflects the significant impairment in quality of life domains that has been reported in cGVHD. 48 We found that adult patients with extensive skin sclerosis (greater than median BSA, 37.4%) had significantly poorer survival than cGVHD patients with limited skin sclerosis or no sclerosis. Extensive skin involvement in cGVHD is generally thought to portend poor survival; however, the specific impact of sclerosis has not been evaluated.…”

Cardiopulmonary fitness in patients undergoing hematopoietic SCT: a pilot study

“…12,13 Functional capacity impairments in patients with chronic GVHD have also been shown to mediate adverse changes in post-HCT functional performance associated with symptom burden. 31 There are limited data regarding 6MW in HCT, 32 and no data that we are aware of that explore the feasibility or prognostic value of cardiopulmonary testing in patients planning to undergo HCT. Muffly et al 33 recently reported on the use of a comprehensive geriatric assessment before allogeneic transplant, which incorporated a 'Frailty Index' that included walk speed and grip strength.…”

Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: report on baseline data from the Chronic GVHD Consortium

“…Second, we have further demonstrated the magnitude of impairment in QOL by comparison of chronic GVHD cohort subjects' mean scores to those of age-and sex-matched US population normative data; these findings complement previously reported data. 35 Those affected by chronic GVHD had significant impairment in QOL across multiple domains. As well, we have for the first time examined the magnitude of impairment in QOL in chronic GVHD affected individuals in reference to that previously reported in the setting of other chronic health conditions.…”