Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study

Fraser, Christopher; Bhatia, Smita; Ness, Kirsten K.; Carter, Andrea; Francisco, Liton; Arora, Mukta; Parker, Pablo; Forman, Stephen J.; Weisdorf, Daniel J.; Gurney, James G.; Baker, K. Scott

doi:10.1182/blood-2006-02-003954

Cited by 247 publications

(209 citation statements)

References 28 publications

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“…[17][18][19][20][21][22] To date, very few studies have investigated the impact of ECP on QoL. In the only randomized controlled trial to date, Flowers et al 10 used a Targeted Symptoms Assessment questionnaire, which included 12 questions to assess the effect of cutaneous, ocular and oral GVHD on various aspects of patients' QoL.…”

Section: Discussionmentioning

confidence: 99%

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Dignan

Aguilar

Scarisbrick

et al. 2014

Bone Marrow Transplant

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There are few prospective studies evaluating the role of extracorporeal photopheresis (ECP) in chronic GVHD (cGVHD) and only occasional reports of the effect of ECP on patients' quality of life (QoL). We report a single-centre prospective study of patients undergoing fortnightly ECP for moderate or severe cGVHD. Response was assessed after 6 months of treatment using NIH scoring criteria and reduction in immunosuppression. QoL assessments were undertaken at baseline and at 6 months using the chronic GVHD symptom scale (cGVHD SS) and dermatology life quality index (DLQI). An intention-to-treat analysis showed that 19/38 (50%) of patients had a complete or partial response. Twenty-seven out of 38 patients completed 6 months of ECP treatment and 70% (19/27) had a complete or partial response. Eighty per cent of patients who completed 6 months of ECP treatment had a reduction in immunosuppression dose. A subset of patients completed QoL questionnaires. Seventeen out of 18 patients (94%) showed an improvement in scores. The mean cGVHD SS and mean DLQI score were both significantly lower after 6 months of ECP (22 compared with 36, P ¼ 0.012 and 3.4 compared with 6.9, P ¼ 0.009, respectively). This study confirms that ECP can lead to objective clinical responses and, in addition, may lead to an improvement in QoL in cGVHD. Our group and others have previously reported the efficacy of ECP in the management of cGVHD in retrospective studies. [2][3][4][5] To date, there are only a few prospective studies of ECP for this condition 6-9 and one randomised prospective trial. 10 In addition, there are few data on the effect of ECP on quality of life (QoL) in patients with cGVHD.In a retrospective study, we have previously shown that a fortnightly regimen of ECP improved the clinical signs and symptoms of cGVHD. 2 The aim of the current report was to prospectively assess the effect of a fortnightly schedule of ECP on the clinical signs and symptoms of cGVHD. The secondary aims were to assess the effect of ECP on health-related QoL and to assess response in terms of change in immunosuppression dose at 6 months.

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Section: Discussionmentioning

confidence: 99%

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Dignan

Aguilar

Scarisbrick

et al. 2014

Bone Marrow Transplant

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“…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.…”

Section: Sf-36 Scoresmentioning

confidence: 99%

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

et al. 2012

Bone Marrow Transplant

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To investigate the health-related quality of life (HRQoL) of patients receiving allogeneic hematopoietic SCT (allo-HSCT) from HLA-haploidentical/partially matched related donors (HID/PMRD) and to compare this value with that of patients receiving allo-HSCT from HLA-identical sibling donor (ISD), a total of 350 patients receiving allo-HSCT were enrolled in a study (ISD: 173; HID/PMRD: 177). HRQoL post transplantation was evaluated by an SF-36 questionnaire. The effect of various factors on the HRQoL was analyzed through COX regression. Compared with the ISD group, patients in the HID/PMRD group had higher scores in physical functioning, general health, bodily pain, vitality and emotional role functioning, and these patients functioned significantly better on the physical and mental component summaries. Also, long-term survivors exhibit better HRQoL. Measured by multivariate analysis, extensive chronic GVHD was observed to have a strongly negative impact on patients' HRQoL, while male gender status, lower age when receiving allo-HSCT and returning to work or school were associated with positive impacts on at least one subscale. These results showed that the HRQoL of patients receiving HID/PMRD hematopoietic SCT (HSCT) is comparable to that of patients receiving ISD HSCT, and HLA disparity is not the factor affecting the HRQoL.

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“…[15][16][17] We assigned a value of 100 to the utility for being alive without relapse at 10 years after chemotherapy alone, and a value of 0 to the utility for being dead in all situations. We assigned a fixed value of 98 to the utility for being alive without active GVHD at 10 years following HSCT, and assigned a value of 70 with a wide plausible range of 0-98 to the utility for being alive with active GVHD at 10 years.…”

Section: Transition Probabilities (Tps) and Utilitiesmentioning

confidence: 99%

A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor

et al. 2010

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Clinical studies using genetic randomization cannot accurately answer whether adult patients with Philadelphia chromosomenegative acute lymphoblastic leukemia (ALL) who have a human leukocyte antigen (HLA)-matched sibling should undergo allogeneic hematopoietic stem cell transplantation (HSCT) or chemotherapy in first remission, as, in these studies, patients without a sibling donor undergo alternative donor transplantation or chemotherapy alone after a relapse. Therefore, we performed a decision analysis to identify the optimal strategy in this setting. Transition probabilities and utilities were estimated from prospective studies of the Japan Adult Leukemia Study Group, the database of the Japan Society for Hematopoietic Cell Transplantation and the literature. The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustments. Subgroup analyses were performed according to risk stratification on the basis of white blood cell count and cytogenetics, and according to age stratification. In analyses without QOL adjustments, allogeneic HSCT in first remission was superior in the whole population (48.3 vs 32.6%) and in all subgroups. With QOL adjustments, a similar tendency was conserved (44.9 vs 31.7% in the whole population). To improve the probability of long-term survival, allogeneic HSCT in first remission is recommended for patients who have an HLA-matched sibling.

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Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study

Cited by 247 publications

References 28 publications

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

Impact of extracorporeal photopheresis on skin scores and quality of life in patients with steroid-refractory chronic GVHD

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

A decision analysis of allogeneic hematopoietic stem cell transplantation in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia in first remission who have an HLA-matched sibling donor

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