Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD

Abstract

Although fatigue is common after allogeneic hematopoietic cell transplantation, little is known about fatigue in patients with chronic GvHD (cGvHD). The aim of this study was to explore factors associated with fatigue in cGvHD. Data were drawn from a sequentially recruited, cross-sectional study of adults with moderate or severe cGvHD (n = 263). Respondents were classified as fatigued or not fatigued based on their response to a single item regarding loss of energy from the Lee cGvHD Symptom Scale. In univariate analysis, factors significantly associated with fatigue included performance status, number of prior cGvHD therapies, cGvHD symptom bother, self-assessed physical and mental health, nutritional status, walk velocity and self-reported physical activity. There were no significant associations between fatigue and disease-related cGvHD variables. Multivariable logistic regression demonstrated that being less active and having pulmonary and/or muscle/joint symptoms were independently associated with fatigue. In conclusion, clinically significant fatigue was prevalent in more than one-third of subjects with cGvHD, and was disabling. Absence of association with measures of cGvHD severity underscores the need to elucidate the pathogenesis of fatigue and its relationship with inflammatory activity. Pulmonary and muscle/joint symptoms and physical inactivity represent potential targets for intervention in clinical studies.

Complementary therapies for fatigue after hematopoietic stem cell transplantation: an integrative review

“…This implies that prior research has focused on patients within the first 100 days after transplant in which fatigue is highly prevalent and can occur in up to 90% of the patients [5]. Yet, studies in HSCT have shown that fatigue may persist for long after day 100 [6][7][8] and therefore studies are needed to evaluate complementary therapies not only during the initial 100 days after transplant, but also during the extended survivorship period. In summary, none of the studies provided definitive evidence of the benefit for any of the therapies discussed.…”

“…In a study that evaluated fatigue in 76 adult allogeneic HSCT recipients, 68% reported fatigue on the day of transplant, 90% at day 30, and 81% at day 100 posttransplant [5]. Despite that fatigue tends to improve after day 100, studies in HSCT survivors have shown that some level of fatigue may persist for years after the initial 100 days [6][7][8]. In a study that evaluated the quality of life in 406 adult HSCT survivors, investigators found that 56% of the patients continued to suffer from fatigue for 1-3 years after transplant [6].…”

“…In another study measuring the prevalence of fatigue in 98 adult HSCT survivors, 35% had persistent severe fatigue, without improvement for up to 15 years after transplant [7]. Recent evidence also indicates that graft-versus-host disease (GVHD) may worsen fatigue in HSCT survivors [8], likely also due to a high inflammatory state. In a survey of 263 patients with moderate to severe chronic GVHD, 84% reported any degree of fatigue and 40% reported fatigue that was described as quite or extremely bothersome [8].…”

“…Recent evidence also indicates that graft-versus-host disease (GVHD) may worsen fatigue in HSCT survivors [8], likely also due to a high inflammatory state. In a survey of 263 patients with moderate to severe chronic GVHD, 84% reported any degree of fatigue and 40% reported fatigue that was described as quite or extremely bothersome [8].…”

Fatigue predicts impaired social adjustment in survivors of allogeneic hematopoietic cell transplantation (HCT)

“…However, cure or control of the underlying primary disease and effective management of transplant-related late complications, may not be accompanied by a full recovery of health status. Late complications including symptom burden (pain, fatigue, insomnia) and chronic graft-versus-host-disease (cGVHD) associated functional impairments are a major contributor to impairments in quality of life among HCT survivors [2][3][4][5]. Given these difficulties, patients may find it challenging to engage in or resume valued activities and daily roles that support higher levels of social well-being including sustaining intimate relationships and participating in activities with friends or family [6].…”