The quality of life following allogeneic hematopoietic stem cell transplantation – a multicenter retrospective study

Abstract

Between January 2011 and December 2012, five hundred and ninety patients (pts) from 6 transplant centers in the Czech Republic filled in the questionnaire for the quantitative measurement of QOL using Functional Assessment of Cancer Therapy-General (FACT-G) version 4. Study cohort characteristics were as follows: 325 males, 340 pts received myeloablative conditioning, 383 pts received PBPC, representation of diagnoses; acute leukemia (n=270), bone marrow failure (n=36), chronic myeloid leukemia (n=74), myelodysplastic/myeloproliferative syndrom (n=110), lymphoproliferative disease (n=93). The median age at allo-HSCT was 43 years (range: 1.7 - 71.0), the median time from allo-HSCT to questionnaire completing was 3.8 years (range: - 0.2 - 21.6). The earliest allo-HSCT was performed in November 1989, the last in September 2012. In this retrospective study, we investigated the impact of various factors on the QOL after allo-HSCT: age, gender, diagnosis, type of conditioning, time from diagnosis to allo-HSCT, disease stage, graft type, donor type, time from allo-HSCT to questionnaire completing, GVHD, relapse. Only data from patients who were more than 3 months after allo-HSCT were used for the multivariate analysis. The overall results of the total FACT-G score (median=85.0; range: 29-108) as well as the results of each specific dimension - PWB (median=23.0; range: 5-28), SWB (median=24.0; range: 7-28), EWB (median= 19.0; range: 4-24), FWB (mean=21.0; range: 2-28) showed a value in the highest quartile of the possible evaluation. In multivariate analysis, an inferior QOL score was reported for patients with aGVHD (p=0.002), cGVHD (p<0.001), QOL decreased with increasing age (p=0.048) and increased with time elapsed since allo-HSCT (p<0.001).Allogeneic HSCT represents an important intervention into the overall integrity of the organism. In particular, the development of GVHD can cause very serious organ, but also mental problems which can significantly reduce the QOL. The QOL is steadily increasing with increasing interval from allo-HSCT but improvement and disappearance of these complications may take many years, and sometimes these effects may probably persist permanently.

Patients’ Main Concerns About Having a Sibling Stem Cell Donor – A Grounded Theory Study

“…The quality of life (QoL) of patients treated with HSCT has been explored in several previous studies [ 6 , 20 - 22 ] mainly showing that QoL deteriorates immediately after HSCT and stabilises or improves after three months [ 21 - 24 ]. Emotional well-being is usually most impaired before and immediately after HSCT, but improves over [ 23 , 24 ].…”

Perceptions of experiences of having a sibling stem cell donor

“…Complications as well as physical and mental problems after HSCT are common and have a great influence on the life of the patients. [28][29][30] During the risk-benefit analysis phase the recipients face uncertainty because they know very little about HSCT. They therefore try to grasp the situation and learn as much as possible to make an informed decision to undergo transplantation.…”

Hematopoietic Stem Cell Transplantation: A Bioethical Lens

“…Sometimes, the problem may centre on different ideas about an acceptable quality of life that often come into play in the decision-making process. The physical and psychological burdens experienced by patients undergoing HSCT are well known [80] and may have short- and long-term quality of life (QOL) consequences, further exacerbating the morbidity of HSCT [81–83]. HSCT has a profound and pervasive impact on the lives of survivors [84]; in a cohort of five hundred and ninety patients from six transplant centres, Valkova et al recently demonstrated that patients with a GVHD had an inferior QOL score and that QOL decreased with increasing age and increased with time elapsed since HSCT.…”

“…HSCT has a profound and pervasive impact on the lives of survivors [84]; in a cohort of five hundred and ninety patients from six transplant centres, Valkova et al recently demonstrated that patients with a GVHD had an inferior QOL score and that QOL decreased with increasing age and increased with time elapsed since HSCT. Despite the fact that QOL increases steadily as more time elapses since HSCT, sometimes, the impact of the consequences of HSCT may persist permanently, thus being a substantial factor in the decision-making process by patients [83]. …”