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Moya-Martínez P, Ortega-Ortega M, Del Pozo-Rubio R. Quality of Life of Hematological Neoplasm Survivors After Hematopoietic Stem Cell Transplantation. Transplant Proc 2024; 56:1847-1855. [PMID: 39242309 DOI: 10.1016/j.transproceed.2024.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE This study aimed to assess changes in the quality of life (QoL) of patients with hematological neoplasms who underwent hematopoietic stem cell transplantation (HSCT), identify factors influencing these changes, and quantify the associated monetary value. METHODS A total of 122 hematopoietic stem cell transplantation (HSCT) recipients participated in the study completing a recall survey with questions about 3 different stages: (1) pre-HSCT (baseline), (2) 6 months post-transplantation, and (3) between the first and fifth post-transplantation years. The study first estimated the incremental variation in QoL between phases and conducted regression analyses to identify factors linked to QoL changes. Second, it explored the transition probabilities of QoL between phases and their monetary value. RESULTS Baseline QoL predominantly determined future QoL changes, with disease type, transplantation type, and other sociodemographic factors proving insignificant. Notably, patients with the lowest baseline QoL experienced greater QoL improvement post-HSCT compared to others. Specifically, 90% of patients elevated their QoL quartile within the first post-transplantation year, with over 20% reaching the highest quartile and an average QoL increase of 0.619. The incremental economic benefit for patients with poor baseline QoL, compared to those with high baseline QoL, was 56,880€. CONCLUSION This study provides new, useful, and relevant information on the evolution of the QoL of these patients. Our findings support that HSCT significantly enhances QoL for survivors with initially low QoL, while those with high pre-HSCT QoL maintain their levels. Furthermore, other factors were not significant contributors to this relationship. The study introduced a novel method to measure the economic benefit of incremental QoL.
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2
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Bulthuis MS, van Gennip LLA, Bronkhorst EM, Blijlevens NMA, Huysmans MCDNJM, van Leeuwen SJM, Thomas RZ. The effect of hematopoietic stem cell transplantation on patient-reported subjective oral dryness: a systematic review focusing on prevalence, severity and distress. Support Care Cancer 2023; 31:449. [PMID: 37421511 PMCID: PMC10329604 DOI: 10.1007/s00520-023-07921-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The aim of the present systematic review is to assess the prevalence and severity of and distress caused by xerostomia over time in adult hematopoietic stem cell transplantation (HSCT) recipients. METHODS PubMed, Embase, and the Cochrane Library were searched for papers published between January 2000 and May 2022. Clinical studies were included if patient-reported subjective oral dryness was reported in adult autologous or allogeneic HSCT recipients. Risk of bias was assessed according to a quality grading strategy published by the oral care study group of the MASCC/ISOO, resulting in a score between 0 (highest risk of bias) and 10 (lowest risk of bias). Separate analysis focused on autologous HSCT recipients, allogeneic HSCT recipients receiving a myeloablative conditioning (MAC), and those receiving a reduced intensity conditioning (RIC). RESULTS Searches yielded 1792 unique records; 22 studies met the inclusion criteria. The quality scores ranged between 1 and 7, with a median score of 4. The prevalence, severity, and distress of xerostomia increased shortly after HSCT. Severity of xerostomia in allogeneic MAC recipients was higher compared to allogeneic RIC recipients 2-5 months post-HSCT (mean difference: 18 points on 0-100 scale, 95% CI: 9-27); after 1-2 years, there was no significant difference anymore. CONCLUSION The prevalence of xerostomia in HSCT recipients is high in comparison to the general population. The severity of complaints is raised during the first year post-HSCT. The intensity of the conditioning plays a key role in the short-term development of xerostomia, while factors affecting the recovery in the long term remain largely unknown.
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Affiliation(s)
- Marjolein S Bulthuis
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Lucky L A van Gennip
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewald M Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole M A Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Renske Z Thomas
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
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Cusatis R, Balza J, Uttke Z, Kode V, Suelzer E, Shaw BE, Flynn KE. Patient-reported cognitive function among hematopoietic stem cell transplant and cellular therapy patients: a scoping review. Qual Life Res 2023; 32:939-964. [PMID: 36203005 PMCID: PMC10259487 DOI: 10.1007/s11136-022-03258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Cognitive dysfunction is a known complication following cellular therapies (CT), which can be assessed through performance based and patient-reported measures. We performed a systematic scoping review to assess self-reported cognitive function measures used among adult CT patients and describe long-term results, including associations with clinical outcomes. METHODS Library databases were searched from inception to February 2020 according to PRISMA guidelines. Additional studies were identified through reference lists and trial protocols. Two members of the research team screened titles and abstracts and resolved discrepancies. Articles that met eligibility criteria continued to full-text review, with 25% double screening. Articles were removed if they (1) were not original research, peer-reviewed articles; (2) were the wrong disease, age, or treatment-specific patient population; (3) did not use patient-reported outcomes; (4) did not separately report cognitive function outcomes. RESULTS Of the1952 articles, 56 were included. Twenty-one patient-reported measures of cognitive function were used; most frequently the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30), which includes a two-item cognitive function subscale (57%; n = 32). Thirteen studies collected performance-based and self-reported measures and of those (n = 6) who assessed associations found moderate correlations (range r = .13-.58). Longitudinal patterns showed declines in cognitive function soon after treatment (< 1 month) returning to baseline at 1 year. Cognitive function was often associated with other quality of life measures, chiefly depression (n = 5). CONCLUSIONS EORTC-QLQ-C30 is the most commonly used to measure, though there remain numerous measures used, including several measures with little previous validation and investigator developed items.
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Affiliation(s)
- Rachel Cusatis
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Joanna Balza
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Zachary Uttke
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Vishwajit Kode
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Bronwen E Shaw
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn E Flynn
- Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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4
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-Specific Late Effects in Adult Hematopoietic Cell Transplantation Recipients: A Systematic Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Transplant Cell Ther 2022; 28:335.e1-335.e17. [PMID: 34757220 PMCID: PMC9050968 DOI: 10.1016/j.jtct.2021.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GVHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies, such as prostate, penile, and testicular cancer. These effects may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. Here we provide a systematic review of male-specific late effects in a collaboration among transplantation physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. We used a systematic review methodology to summarize incidence, risk factors, screening, prevention, and treatment of these complications and provide consensus evidence-based recommendations for clinical practice and future research. Most of the evidence regarding male GVHD is still based on limited data, precluding strong therapeutic recommendations. Therefore, we recommend systematic screening for male genital GVHD regularly and reporting of cases to large registries to allow for a better understanding. Future research also should address treatment, given the little published evidence currently available. Male-specific endocrine consequences of HCT include hypogonadism, which also may affect bone health. Given the scanty evidence, current recommendations for hormone substitution and/or bone health treatment are based on similar principles as for the general population. Following HCT, sexual health decreases, and this topic should be addressed at regular intervals. Future studies should focus on interventional strategies to address sexual dysfunction. Infertility remains prevalent in patients having undergone myeloablative conditioning, warranting the offer of sperm preservation for all HCT candidates. Most studies on fertility rely on descriptive registry analysis and surveys, underscoring the importance of reporting post-HCT conception data to large registries. Although the quality of evidence is low, the development of cancer in male genital organs does not seem more prevalent in HCT recipients compared with the general population; however, subsequent malignancies in general seem to be more prevalent in males than in females, and special attention should be given to skin and oral mucosa. Male-specific late effects, which likely are more underreported than female-specific complications, should be systematically considered during the regular follow-up visits of male survivors who have undergone HCT. Care of patients with male-specific late effects warrants close collaboration between transplantation physicians and specialists from other involved disciplines. Future research should be directed toward better data collection on male-specific late effects and on studies about the interrelationships among these late effects, to allow the development of evidence-based effective management practices.
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Affiliation(s)
- Rachel Phelan
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Linda Burns
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, Colorado
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Pinki Prasad
- Department of Pediatrics, Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, North Carolina
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Hermann Einsele
- Department of Internal Medicine II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida
| | | | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, Florida
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, Pennsylvania
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, Illinois
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School, University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School, University of Zagreb, Zagreb, Croatia
| | - Richard Ross
- University of Sheffield, Sheffield, United Kingdom
| | - Andrea Salonia
- University of Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, California
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - John A Snowden
- University of Sheffield, Sheffield, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York New York
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium;; Department of Public Health and Primary Care, ACCENT VV, University of Leuven, Leuven, Belgium
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5
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Phelan R, Im A, Hunter RL, Inamoto Y, Lupo-Stanghellini MT, Rovo A, Badawy SM, Burns L, Eissa H, Murthy HS, Prasad P, Sharma A, Suelzer E, Agrawal V, Aljurf M, Baker K, Basak GW, Buchbinder D, DeFilipp Z, Grkovic LD, Dias A, Einsele H, Eisenberg ML, Epperla N, Farhadfar N, Flatau A, Gale RP, Greinix H, Hamilton BK, Hashmi S, Hematti P, Jamani K, Maharaj D, Murray J, Naik S, Nathan S, Pavletic S, Peric Z, Pulanic D, Ross R, Salonia A, Sanchez-Ortega I, Savani BN, Schechter T, Shah AJ, Smith SM, Snowden JA, Steinberg A, Tremblay D, Vij SC, Walker L, Wolff D, Yared JA, Schoemans H, Tichelli A. Male-specific late effects in adult hematopoietic cell transplantation recipients: a systematic review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Bone Marrow Transplant 2022; 57:1150-1163. [PMID: 35523848 DOI: 10.1038/s41409-022-01591-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/10/2021] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
Male-specific late effects after hematopoietic cell transplantation (HCT) include genital chronic graft-versus-host disease (GvHD), hypogonadism, sexual dysfunction, infertility, and subsequent malignancies. They may be closely intertwined and cause prolonged morbidity and decreased quality of life after HCT. We provide a systematic review of male-specific late effects in a collaboration between transplant physicians, endocrinologists, urologists, dermatologists, and sexual health professionals through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research, and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. The systematic review summarizes incidence, risk factors, screening, prevention and treatment of these complications and provides consensus evidence-based recommendations for clinical practice and future research.
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Affiliation(s)
- Rachel Phelan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Annie Im
- University of Pittsburgh/UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Rebecca L Hunter
- Division of Hematology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Yoshihiro Inamoto
- Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | | | - Alicia Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Burns
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hesham Eissa
- Department of Pediatrics, Center for Cancer and Blood Disorders, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hemant S Murthy
- Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL, USA
| | - Pinki Prasad
- Louisiana State University Health Sciences Center/Children's Hospital of New Orleans, Department of Pediatrics, New Orleans, LA, USA
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Vaibhav Agrawal
- Division of Leukemia, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia
| | - Karen Baker
- Duke University Medical Center, Durham, NC, USA
| | - Grzegorz W Basak
- University Clinical Centre, Medical University of Warsaw, Warsaw, Poland
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, CA, USA
| | - Zachariah DeFilipp
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | | | - Ajoy Dias
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Department of Internal Medicine II, Würzburg, Germany
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Narendranath Epperla
- Division of Hematology, Department of Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Nosha Farhadfar
- Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Arthur Flatau
- Association of Cancer Online Resources, Association of Cancer Online Resources, Austin, TX, USA
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
| | | | - Betty K Hamilton
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Shahrukh Hashmi
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Peiman Hematti
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Kareem Jamani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Dipnarine Maharaj
- South Florida Bone Marrow Stem Cell Transplant Institute, Boynton Beach, FL, USA
| | - John Murray
- The Christie NHS Foundation Trust, Manchester, UK
| | - Seema Naik
- Division Hematology and Oncology, Department of Medicine, Penn State Cancer Institute, Milton Hershey Medical Center, Hershey, PA, USA
| | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Zinaida Peric
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- University Hospital Centre Zagreb and Medical School University of Zagreb, Zagreb, Croatia
| | | | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Bipin N Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tal Schechter
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ami J Shah
- Division of Hematology/ Oncology/ Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA, USA
| | - Stephanie M Smith
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - John A Snowden
- The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Douglas Tremblay
- Division of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Walker
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Daniel Wolff
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Jean A Yared
- Blood & Marrow Transplantation Program, Division of Hematology/Oncology, Department of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, USA
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium
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6
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Servais S, Beguin Y, Baron F. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:461-477. [PMID: 35438781 PMCID: PMC9154332 DOI: 10.1093/stcltm/szac015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.
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Affiliation(s)
- Sophie Servais
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Yves Beguin
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Frédéric Baron
- Corresponding author: Baron Frédéric, Clinical Hematology Department, University of Liège, CHU of Liège (Sart-Tilman), 4000 Liège, Belgium. Tel: +32 4 366 72 01;
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7
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Gorin NC. History and Development of Autologous Stem Cell Transplantation for Acute Myeloid Leukemia. Clin Hematol Int 2021; 3:83-95. [PMID: 34820613 PMCID: PMC8486970 DOI: 10.2991/chi.k.210703.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
This review describes the development of cryopreservation, the birth of autologous stem cell transplantation (ASCT) and its past and present use to consolidate adult patients with acute myelogenous leukemia (AML). It summarizes the first autografts in patients in relapse, the experience of autografting in complete remission (CR), using bone marrow unpurged or purged in vitro with cyclophosphamide-derivatives, and the important shift to peripheral blood stem cells. The review also discusses the results of recent studies in favor of the use of ASCT to consolidate good- and intermediate-risk patients who reach CR with no detectable minimal residual disease, and those which support the inclusion of maintenance therapy post autograft with hypomethylating agents, anti-BCL-2, and, possibly, in the future, anti AML chimeric antigen receptor-T cells. Carefully applied to well-selected patients, ASCT may regain interest, because of its simplicity, its reduced toxicity, lower non-relapse mortality and better quality of life.
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Affiliation(s)
- Norbert Claude Gorin
- Department of Hematology and Cell Therapy, and EBMT Global Committee, Hopital Saint-Antoine APHP, Paris Sorbonne University, Paris, France
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8
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Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant 2021; 11:263-276. [PMID: 34316451 PMCID: PMC8290998 DOI: 10.5500/wjt.v11.i7.263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation-liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented.
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Affiliation(s)
- Henrietta Janicsák
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame, Fremantle 6009, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth 6009, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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9
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Rönkkö R, Hirvonen E, Malila N, Kilpivaara O, Wartiovaara-Kautto U, Pitkäniemi J. Familial aggregation of early-onset haematological malignancies. Br J Haematol 2021; 193:1134-1141. [PMID: 34002362 DOI: 10.1111/bjh.17477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
Population-based studies on familial aggregation of haematological malignancies (HM) have rarely focused specifically on early-onset HMs. We estimated standardized incidence ratios (SIR) and cumulative risks of relatives with Hodgkin lymphoma (HL), non-Hodgkin lymphomas (NHL), acute lymphoblastic leukaemia/lymphoma (ALL/LBL) and acute myeloid leukaemia (AML) when index persons and relatives were diagnosed with early-onset HM. A total of 8791 patients aged ≤40 years and diagnosed with primary HM in Finland from 1970 to 2012 were identified from the Finnish Cancer Registry and their 75 774 family members were retrieved from the population registry. SIRs for concordant HMs were elevated among first-degree relatives in all of the most common HMs of children and adolescents and young adults (AYA). The risk was highest among siblings with HL (SIR 9·09, 95% confidence interval 5·55-14·04) and AML (8·29, 1·00-29·96). HL also had the highest cumulative risk for siblings at ≤40 years of age (0·92% vs. 0·11% in the population). In conclusion, significantly elevated SIRs indicate a role of shared aetiological factors in some families, which should be noted in the clinical setting when caring for patients with early-onset HMs.
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Affiliation(s)
- Rosa Rönkkö
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.,Department of Hematology, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Outi Kilpivaara
- Applied Tumor Genomics, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,HUSLAB Laboratory of Genetics, HUS Diagnostic Center (Helsinki University Hospital), Helsinki, Finland
| | - Ulla Wartiovaara-Kautto
- Department of Hematology, University of Helsinki, Helsinki, Finland.,Applied Tumor Genomics, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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10
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Bruserud Ø, Tsykunova G, Hernandez-Valladares M, Reikvam H, Tvedt THA. Therapeutic Use of Valproic Acid and All-Trans Retinoic Acid in Acute Myeloid Leukemia-Literature Review and Discussion of Possible Use in Relapse after Allogeneic Stem Cell Transplantation. Pharmaceuticals (Basel) 2021; 14:ph14050423. [PMID: 34063204 PMCID: PMC8147490 DOI: 10.3390/ph14050423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Even though allogeneic stem cell transplantation is the most intensive treatment for acute myeloid leukemia (AML), chemo-resistant leukemia relapse is still one of the most common causes of death for these patients, as is transplant-related mortality, i.e., graft versus host disease, infections, and organ damage. These relapse patients are not always candidates for additional intensive therapy or re-transplantation, and many of them have decreased quality of life and shortened expected survival. The efficiency of azacitidine for treatment of posttransplant AML relapse has been documented in several clinical trials. Valproic acid is an antiepileptic fatty acid that exerts antileukemic activity through histone deacetylase inhibition. The combination of valproic acid and all-trans retinoic acid (ATRA) is well tolerated even by unfit or elderly AML patients, and low-toxicity chemotherapy (e.g., azacitidine) can be added to this combination. The triple combination of azacitidine, valproic acid, and ATRA may therefore represent a low-intensity and low-toxicity alternative for these patients. In the present review, we review and discuss the general experience with valproic acid/ATRA in AML therapy and we discuss its possible use in low-intensity/toxicity treatment of post-allotransplant AML relapse. Our discussion is further illustrated by four case reports where combined treatments with sequential azacitidine/hydroxyurea, valproic acid, and ATRA were used.
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Affiliation(s)
- Øystein Bruserud
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway;
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
- Correspondence:
| | - Galina Tsykunova
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
| | - Maria Hernandez-Valladares
- The Proteomics Facility of the University of Bergen (PROBE), University of Bergen, N-5021 Bergen, Norway;
| | - Hakon Reikvam
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway;
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway; (G.T.); (T.H.A.T.)
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11
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Burnett AK, Hills RK, Russell N. Twenty five years of UK trials in acute myeloid leukaemia: what have we learned? Br J Haematol 2020; 188:86-100. [PMID: 31828788 DOI: 10.1111/bjh.16359] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan K Burnett
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow, UK
| | - Robert K Hills
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nigel Russell
- Department of Haematology, Centre for Clinical Haematology, Nottingham University Hospital (City Campus), Nottingham, UK
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12
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Park EG, Yi ES, Choi YB, Sung KW, Koo HH, Yoo KH. Unrelated donor hematopoietic stem cell transplantation for pediatric de novo acute myeloid leukemia with intermediate- or high-risk cytogenetics. Pediatr Transplant 2019; 23:e13397. [PMID: 30955250 DOI: 10.1111/petr.13397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/10/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022]
Abstract
The role of unrelated donor HSCT for children with de novo AML in CR1 is controversial. We performed this study to investigate the feasibility of unrelated donor HSCT who initially had intermediate- or high-risk cytogenetics. We retrospectively reviewed medical records of patients with AML who received unrelated HSCT in CR1 at Samsung Medical Center between November 2001 and January 2012. Patients were allocated based on karyotype at diagnosis as follows: (a) low-risk: inv(16), t(16;16), t(8;21), and t(15;17); (b) high-risk: -5, 5q-, -7, 3q abnormalities, t(8;16), t(6;9), t(6;11), t(6;21), t(10;11), complex karyotype (≥3 abnormalities), and acute megakaryocytic leukemia without t(1;22); and (c) IR: all the other karyotypes including normal. Patients in intermediate- or high-risk group who were transplanted with either unrelated CB or matched unrelated BM/mobilized PB in their CR1 were included in this study. The projected OS and EFS rates were 74.9% and 71.1%, respectively, with a median follow-up of 87.3 months after transplantation. The EFS was 70.1%, 80.7%, and 73.9% for CB, BM, and mobilized PB groups, respectively (P = 0.89), and 73.9% and 70.6% for IR and high-risk groups (P = 0.76). The leading cause of death was relapse (n = 8), and only one patient died from non-relapse cause. Unrelated donor HSCT seems a feasible approach for children with intermediate- or high-risk AML in CR1. Relapse remains the leading cause of treatment failure among these patients.
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Affiliation(s)
- Eu Gene Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea
| | - Young Bae Choi
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Vandekerckhove K, De Waele K, Minne A, Coomans I, De Groote K, Panzer J, Dhooge C, Bordon V, De Wolf D, Boone J. Evaluation of cardiopulmonary exercise testing, heart function, and quality of life in children after allogenic hematopoietic stem cell transplantation. Pediatr Blood Cancer 2019; 66:e27499. [PMID: 30318730 DOI: 10.1002/pbc.27499] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/05/2018] [Accepted: 09/15/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Physical fitness is an important determinant of quality of life (QOL) after hematopoietic stem cell transplantation. Cardiac function can influence exercise performance. The aim of this study was to assess these factors and their interrelationship. PROCEDURE Children underwent cardiopulmonary exercise testing (CPET) at least 1 year after hematopoietic stem cell transplantation (HSCT) and were compared with healthy controls. Systolic and diastolic heart function and left ventricle (LV) wall dimensions were measured. Health-related QOL (HR-QOL) was evaluated using PedsQL questionnaires. RESULTS Forty-three patients performed CPET (26 boys, 13.6 ± 3.4 years, weight 45.5 ± 13.3 kg, length 152.9 ± 17.5 cm, body surface area 1.35 ± 0.28). HSCT patients had lower maximal oxygen consumption (VO2peak/kg, 34.7 ± 8.4 vs 46.3 ± 7.1 mL/kg/min, P < 0.001), shorter exercise duration (9.1 ± 2.5 vs 12.9 ± 2.6 min, P < 0.001), and lower maximal load (%Ppeak 70.8 ± 19.7 vs 102.4% ± 15.9%, P < 0.001). Echocardiography demonstrated decreased interventricular septal wall thickness (interventricular septum in diastole [IVSd] Z-value -0.64 ± 0.69, P < 0.001), and more systolic (11% of patients) and diastolic dysfunction (high E/E' Z-value 1.06 ± 1.13, P < 0.001). LV dilatation correlates with VO2max/kg (r = -0.364, P = 0.017). HR-QOL showed lower overall and emotional functioning scores (respectively, P = 0.016 and P = 0.001). Patients after anthracycline therapy have the lowest maximal exercise performance, but have no difference in QOL. Diminished exercise performance is not encountered as a QOL limitation. Total body irradiation influences the domain of psychosocial functioning. CONCLUSIONS LV (systolic and diastolic) and right ventricle dysfunctions justify the need for thorough cardiac follow-up in children after HSCT. Lower physical fitness levels and lower HR-QOL emphasize the importance of CPET and fitness programs.
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Affiliation(s)
| | - Kathleen De Waele
- Department of Pediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Aurelie Minne
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Ilse Coomans
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Joseph Panzer
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Catherine Dhooge
- Department of Pediatric Hematology, Oncology and SCT, Ghent University Hospital, Ghent, Belgium
| | - Victoria Bordon
- Department of Pediatric Hematology, Oncology and SCT, Ghent University Hospital, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Jan Boone
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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14
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Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia. Leukemia 2018; 33:1598-1607. [DOI: 10.1038/s41375-018-0325-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
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15
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Levin-Epstein R, Oliai C, Schiller G. Allogeneic Hematopoietic Stem Cell Transplantation for Older Patients With Acute Myeloid Leukemia. Curr Treat Options Oncol 2018; 19:63. [PMID: 30362051 DOI: 10.1007/s11864-018-0577-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OPINION STATEMENT Acute myelogenous leukemia (AML) in the elderly is complex and has a poor prognosis, often characterized by higher risk cytogenetic and molecular features compared to that in younger patients. Rates of transplant have been limited by concern related to non-relapse mortality, as older patients have historically been considered medically unfit for the transplantation process. Reduced-intensity conditioning (RIC) for hematopoietic stem cell transplantation (HSCT) has been shown to provide similar efficacy to myeloablative methods, with decreased non-relapse mortality in the elderly and improved efficacy over non-transplant approaches with cytotoxic chemotherapy alone. Targeted non-cytotoxic and modified cytotoxic agents have emerged to further improve transplant outcomes for older AML patients. Validated comorbidity indices are useful tools to assess an individual's fitness for undergoing HSCT rather than chronological age alone. We believe HSCT is the primary curative treatment approach for many older AML patients, taking into account risk and comorbidities, particularly given the tendency of leukemia in this population to harbor an unfavorable disease profile. We use RIC and advocate for the addition of targeted agents if applicable. With continuing data in support of transplant for older AML patients, we anticipate that transplant rates in this population will continue to rise.
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Affiliation(s)
- Rebecca Levin-Epstein
- UCLA Department of Radiation Oncology, 200 Medical Plaza, Suite B265, Los Angeles, CA, 90095, USA.
| | - Caspian Oliai
- UCLA Department of Hematology Oncology, 200 Medical Plaza, Suite 120, Los Angeles, CA, 90095, USA
| | - Gary Schiller
- UCLA Department of Hematology Oncology, 200 Medical Plaza, Suite 120, Los Angeles, CA, 90095, USA
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16
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Islam MS. Treat patient, not just the disease: holistic needs assessment for haematological cancer patients. Oncol Rev 2018; 12:374. [PMID: 30283608 PMCID: PMC6151346 DOI: 10.4081/oncol.2018.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/20/2018] [Indexed: 12/25/2022] Open
Abstract
Haematological malignancies can have devastating effects on the patients' physical, emotional, psycho-sexual, educational and economic health. With the improvement of therapies patients with these malignancies are living longer, however significant proportion these patient show poor quality of life (QoL) due to various physical and psychological consequences of the disease and the treatments. Health-related QoL (HRQoL) is multi-dimensional and temporal, relating to a state of functional, physical, psychological and social/family well-being. Compared with the general population, HRQoL of these patients is worse in most dimensions. However without routine holistic need assessment (HNA), clinicians are unlikely to identify patients with clinically significant distress. Surviving cancer is a chronic life-altering condition with several factors negatively affecting their QoL, such as psychological problems, including depression and excessive fear of recurrence, as well as social aspects, such as unemployment and social isolation. These need to be adequately understood and addressed in the healthcare of long-term survivors of haematological cancer. Applying a holistic approach to patient care has many benefits and yet, only around 25% of cancer survivors in the UK receive a holistic needs assessment. The efforts of the last decade have established the importance of ensuring access to psychosocial services for haematological cancer survivors. We need to determine the most effective practices and how best to deliver them across diverse settings. Distress, like haematological cancer, is not a single entity, and one treatment does not fit all. Psychosocialoncology needs to increase its research in comparative effectiveness.
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Affiliation(s)
- Md Serajul Islam
- Department of Haematology, Guy's & St. Thomas Hospital, London.,Department of Haematology, Broomfield Hospital, Chelmsford, UK
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17
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Bryant AL, Drier SW, Lee S, Bennett AV. A systematic review of patient reported outcomes in phase II or III clinical trials of myelodysplastic syndromes and acute myeloid leukemia. Leuk Res 2018; 70:106-116. [DOI: 10.1016/j.leukres.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/16/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
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18
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Long-term recovery of quality of life and physical function over three years in adult survivors of acute myeloid leukemia after intensive chemotherapy. Leukemia 2018; 33:15-25. [PMID: 29884902 DOI: 10.1038/s41375-018-0162-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/07/2018] [Accepted: 04/13/2018] [Indexed: 02/04/2023]
Abstract
We previously described impairments in quality of life (QOL) and physical function among acute myeloid leukemia (AML) survivors between diagnosis and 1 year. The aim of the current study is to describe and compare to normative data QOL and physical function recovery over 3 years from diagnosis and treatment with intensive chemotherapy (IC). At assessments done at baseline (pre-IC) and at 11 time points over 3 years, QOL, fatigue, and 3 physical performance measures (PPMs; grip strength, 6-min walk test (6MWT), and timed chair stands) were collected. Long-term recovery was defined by reaching scores within the minimum clinically important difference of normative data. Global QOL recovery was seen in 79% at 1 year, 75% at 2 years, and 86% at 3 years. At 3 years, the QLQ-C30 subscales with the greatest recovery were physical and emotional functioning. For FACT-fatigue, recovery was seen in 68% at 1 year and 77% at 3 years. Recovery on PPMs was poorer on average, with only 17% on the 6MWT and 42% in grip strength returning to normal at 3 years. The vast majority of AML survivors after IC achieve recovery in QOL and fatigue by three years. However, recovery in physical performance remained blunted.
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19
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Nelson AM, Jim HSL, Small BJ, Nishihori T, Gonzalez BD, Cessna JM, Hyland KA, Rumble ME, Jacobsen PB. Sleep disruption among cancer patients following autologous hematopoietic cell transplantation. Bone Marrow Transplant 2017; 53:307-314. [PMID: 29269811 PMCID: PMC5851802 DOI: 10.1038/s41409-017-0022-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/01/2017] [Accepted: 09/07/2017] [Indexed: 12/14/2022]
Abstract
Despite a high prevalence of sleep disruption among hematopoietic cell transplant (HCT) recipients, relatively little research has investigated its relationships with modifiable cognitive or behavioral factors or used actigraphy to characterize sleep disruption in this population. Autologous HCT recipients who were 6 to 18 months post-transplant completed self-report measures of cancer-related distress, fear of cancer recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors upon enrollment. Patients then wore an actigraph for seven days and completed a self-report measure of sleep disruption on day seven of the study. Among the 84 participants (age M=60, 45% female), 41% reported clinically-relevant sleep disruption. Examination of actigraph data confirmed that, on average, sleep was disrupted (wake after sleep onset M=66 minutes) and sleep efficiency was less than recommended (sleep efficiency M=78%). Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors were related to self-reported sleep disruption (p’s < .05) but not objective sleep indices. Results suggest that many HCT recipients experience sleep disruption after transplant. Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and maladaptive sleep behaviors are related to self-reported sleep disruption and should be considered targets for cognitive behavioral intervention in this population.
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Affiliation(s)
- Ashley M Nelson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Taiga Nishihori
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Julie M Cessna
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Meredith E Rumble
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul B Jacobsen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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20
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Cheng MJ, Smith BD, Hourigan CS, Gojo I, Pratz KW, Blackford AL, Mehta AK, Smith TJ. A Single Center Survey of Health-Related Quality of Life among Acute Myeloid Leukemia Survivors in First Complete Remission. J Palliat Med 2017; 20:1267-1273. [PMID: 28537498 DOI: 10.1089/jpm.2017.0069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) is one of the most common types of leukemia in adults, but there is limited information on survivors' quality of life (QOL) after remission. OBJECTIVE We piloted a survey exploring patient-reported outcomes for people with AML in first complete remission (CR1) to determine whether patients felt the survey is relevant to their well-being and to summarize patient characteristics. DESIGN/MEASUREMENTS Cross-sectional survey of a convenience sample of AML patients in CR1 assessing QOL and functioning (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30 v 3.0), well-being (QOL-cancer survivor [QOL-CS]), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-Fatigue]), and anxiety and depression (hospital anxiety and depression scale [HADS]). The survey contained five open-ended questions. RESULTS Eighteen patients completed the survey. Most felt it was completely or mostly relevant (88.8%) in describing their QOL. Participants scored well on the EORTC QLQ-C30, fatigue being the most common symptom (83%).The FACIT-Fatigue mean score was 28.7 and median score was 33.5 (normal ≥30). Two scored in the abnormal range for anxiety and one for depression on the HADS. On the QOL-CS, participants scored more than 6 out of 10 in most domains, except the subscales of distress and fear. CONCLUSIONS The survey content and length were appropriate. Patients reported ongoing fatigue, fears of future test results, getting a second cancer, and recurrence of cancer. Survivors experience ongoing symptoms, highlighting the importance of providers performing ongoing symptom and needs assessments.
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Affiliation(s)
- M Jennifer Cheng
- 1 Pain and Palliative Care Service, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - B Douglas Smith
- 2 Division of Hematologic Malignancies, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital , Baltimore, Maryland
| | - Christopher S Hourigan
- 3 Myeloid Malignancies Section, Hematology Branch, National Heart, Lung and Blood Institute , Baltimore, Maryland
| | - Ivana Gojo
- 2 Division of Hematologic Malignancies, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital , Baltimore, Maryland
| | - Keith W Pratz
- 2 Division of Hematologic Malignancies, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital , Baltimore, Maryland
| | - Amanda L Blackford
- 4 Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University , Baltimore, Maryland
| | - Ambereen K Mehta
- 1 Pain and Palliative Care Service, Clinical Center, National Institutes of Health , Bethesda, Maryland
| | - Thomas J Smith
- 5 Program in Palliative Medicine and Department of Medical Oncology, Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital , Baltimore, Maryland
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21
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Korol EE, Wang S, Johnston K, Ravandi-Kashani F, Levis M, van Nooten F. Health-Related Quality of Life of Patients with Acute Myeloid Leukemia: A Systematic Literature Review. Oncol Ther 2017; 5:1-16. [PMID: 28680951 PMCID: PMC5488112 DOI: 10.1007/s40487-016-0039-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Patients with acute myeloid leukemia (AML), especially those with relapsed or refractory AML, have poor clinical prognosis and outcomes. Health-related quality of life (HRQoL) assessments have become increasingly important in oncology, aiding in identifying and informing supportive therapy needs during treatment and beyond; however, HRQoL in hematology, and AML in particular, has received relatively minor attention. The aim was to identify and summarize estimates of HRQoL in patients with AML, including patients with relapsed or refractory AML. METHODS A systematic literature review was performed. MEDLINE and EMBASE databases were searched for peer-reviewed literature published between 2004 and 2014 in the US and Europe. Abstracts from four relevant conference proceedings between 2012 and 2014 were reviewed. Data from eligible studies were extracted describing the HRQoL instruments used, domains assessed, and HRQoL scores reported. RESULTS Fourteen peer-reviewed studies met the eligibility criteria and were included in the review. Cancer- or leukemia-specific HRQoL measures were used in 78.6% of the studies. Overall, HRQoL was superior among AML survivors compared to individuals on active treatment. Fatigue was identified as the most problematic symptom domain in patients, irrespective of their treatment status. Reported HRQoL declined shortly after diagnosis or treatment initiation and recovered over time. CONCLUSION The included studies identified a decrease in HRQoL after treatment initiation and highlighted the role of fatigue in HRQoL in this patient population. Limited HRQoL data were identified among relapsed or refractory AML patients although they have worse prognostic outcomes. New treatment options that have less negative impact on HRQoL or health initiatives specifically targeting HRQoL of patients with AML are warranted. In addition, further studies exploring HRQoL in the relapsed or refractory patient population are needed to inform disease management and treatment decisions.
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Affiliation(s)
- Ellen E Korol
- ICON Commercialisation and Outcomes, 450-688 West Hastings Street, Vancouver, BC V6B1P1 Canada
| | - Sisi Wang
- ICON Commercialisation and Outcomes, 450-688 West Hastings Street, Vancouver, BC V6B1P1 Canada
| | - Karissa Johnston
- ICON Commercialisation and Outcomes, 450-688 West Hastings Street, Vancouver, BC V6B1P1 Canada
| | | | - Mark Levis
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD USA
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22
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Gorin NC, Labopin M, Czerw T, Pabst T, Blaise D, Dumas PY, Nemet D, Arcese W, Trisolini SM, Wu D, Huynh A, Zuckerman T, Meijer E, Cagirgan S, Cornelissen J, Houhou M, Polge E, Mohty M, Nagler A. Autologous stem cell transplantation for adult acute myelocytic leukemia in first remission-Better outcomes after busulfan and melphalan compared with busulfan and cyclophosphamide: A retrospective study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Cancer 2016; 123:824-831. [PMID: 27906458 DOI: 10.1002/cncr.30400] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/24/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) for adult acute myelogenous leukemia (AML) is a valid therapeutic option for patients with good-risk and intermediate-risk disease. The authors used the registry of the European Society for Blood and Marrow Transplantation to compare combined busulfan and melphalan (BUMEL) with combined busulfan and cyclophosphamide (BUCY) before transplantation. METHODS From 2005 to 2013, 853 patients with available cytogenetics underwent ASCT in first remission, including 257 after receiving BUMEL and 596 after receiving BUCY. The proportion of patients with good-risk AML was lower in those who received BUMEL (14% vs 20%; P = .02). More patients who received BUMEL underwent autograft in molecular remission (89% vs 78%; P = .02). Three years after transplantation, the relapse incidence (RI) was 48.7%, the leukemia-free survival (LFS) rate was 47.7%, the overall survival (OS) rate was 66.2%, and the nonrelapse mortality (NRM) rate was 3.6%. RESULTS Patients who underwent an autograft after receiving BUMEL fared better than those who underwent an autograft after receiving BUCY with a lower RI (39.5% vs 52.2%; hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.49-0.87; P = .003) a better LFS (55.4% vs 44.6%; HR, 0.69; 95% CI, 0.53-0.89; P = .005), and a better OS (73.8% vs 63%; HR, 0.62; 95% CI, 0.47-0.82; P = .0007). There was no difference in the NRM rate (BUMEL vs BUCY, 4.5% vs 3.2%, respectively). Among 74 patients in the BUMEL group and 187 in the BUCY group who underwent autograft in molecular remission, the RI was 30% versus 51%, respectively (univariate analysis; P = .01), and the LFS rate was 66% versus 47%, respectively (univariate analysis; P = .03). CONCLUSIONS In patients with AML in first complete remission who undergo ASCT, the BUMEL combination is a better preparative regimen. Cancer 2017;123:824-31. © 2016 American Cancer Society.
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Affiliation(s)
- Norbert-Claude Gorin
- Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.,EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France
| | - Myriam Labopin
- EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France
| | - Tomasz Czerw
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Thomas Pabst
- Department of Oncology, University Hospital Bern, Bern, Switzerland
| | - Didier Blaise
- Aix Marseille University, CNRS, INSERM, CRCM, Institut Paoli-calmettes, Marseille, France
| | - Pierre-Yves Dumas
- Department of Hematology, Haut-Leveque Hospital, University Hospital Center of Bordeaux, Pessac, France
| | - Damir Nemet
- Department of Hematology, University Hospital Center Rebro, Zagreb, Croatia
| | - William Arcese
- Stem Cell Transplant Unit, Rome Transplant Network, Tor Vergata University Polyclinic, Tor Vergata University, Rome, Italy
| | - Silvia Maria Trisolini
- Department of Cellular Biotechnology and Hematology, Louisiana Sapienza University, Rome, Italy
| | - Depei Wu
- Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou Jiangsu, China
| | - Anne Huynh
- The Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, Haifa, Israel
| | - Ellen Meijer
- Department of Hematology, Free University Medical Center, Amsterdam, the Netherlands
| | - Seckin Cagirgan
- Department of Hematology, Ege University Medical School, Izmir, Turkey
| | - Jan Cornelissen
- Daniel den Hoed Cancer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mohamed Houhou
- Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France
| | - Emmanuelle Polge
- Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France
| | - Mohamad Mohty
- Department of Hematology and Cellular Therapy, European Society for Blood and Marrow Transplantation (EBMT), National Institute of Health and Medical Research (INSERM) Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France
| | - Arnon Nagler
- EBMT Office, INSERM Unit 938, St. Antoine Public Assistance Hospital, Pierre and Marie Curie University, Paris, France.,Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
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23
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Rashidi A, DiPersio JF. Quality of Life: A Tiebreaker in CEBPA Double-Mutated Acute Myeloid Leukemia. Biol Blood Marrow Transplant 2016; 22:1535-1536. [DOI: 10.1016/j.bbmt.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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24
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Hacker ED, Kapella MC, Park C, Ferrans CE, Larson JL. Sleep Patterns During Hospitalization Following Hematopoietic Stem Cell Transplantation. Oncol Nurs Forum 2016; 42:371-9. [PMID: 26148316 DOI: 10.1188/15.onf.371-379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE/OBJECTIVES To characterize patient-reported and objective sleep assessments and provide a preliminary examination of the relationships among sleep, quality of life, and demographic or treatment factors. DESIGN A secondary data analysis using a descriptive-correlational design. SETTING University of Illinois Hospital and Health Sciences System. SAMPLE 40 patients undergoing a hematopoietic stem cell transplantation (HCT) hospitalized for the conditioning regimen, stem cell infusion, and immediate recovery period. METHODS Each patient wore a wrist actigraph continuously from the fourth day following HCT to the eighth day to objectively assess sleep patterns (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings). At the end of the five-day period, patients completed measures of sleep disturbance and quality of life. MAIN RESEARCH VARIABLES Objective sleep (total sleep time, sleep onset latency, sleep efficiency, wake after sleep onset, and number of awakenings), subjective sleep (sleep disturbance), and quality of life. FINDINGS The mean total nighttime sleep (objectively obtained) was 232 minutes (SD = 71 minutes), with 14 patients (35%) sleeping less than three consecutive hours during one or more study days. Age was negatively correlated with patient-reported sleep disturbance. Patient-reported sleep disturbance was significantly associated with length of hospital stay. No correlations were found between patient-reported and objective sleep assessments. CONCLUSIONS This study objectively documents inadequate and irregular sleep in hospitalized patients undergoing HCT. Sole reliance on patient-reported sleep assessments may not represent the full extent of the problem. IMPLICATIONS FOR NURSING Attempts to streamline care during the night by not waking patients for routine care unless indicated by the patient's condition (as advocated by the American Academy of Nursing) and providing supportive care for symptoms (such as diarrhea) during the night may reduce the number of awakenings and possibly improve overall sleep quality.
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Affiliation(s)
| | | | | | | | - Janet L Larson
- Division of Acute, Critical, and Long-Term Care, School of Nursing, University of Michigan in Ann Arbor
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25
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Bower H, Andersson TML, Björkholm M, Dickman PW, Lambert PC, Derolf ÅR. Continued improvement in survival of acute myeloid leukemia patients: an application of the loss in expectation of life. Blood Cancer J 2016; 6:e390. [PMID: 26849011 PMCID: PMC4771966 DOI: 10.1038/bcj.2016.3] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 01/24/2023] Open
Abstract
We evaluated temporal trends in survival of Swedish acute myeloid leukemia (AML) patients diagnosed between 1973 and 2011 using relative survival ratios (RSRs) and a measure called the loss in expectation of life (LEL). RSRs increased most for patients <60 years at diagnosis during the first calendar periods, but between 1997-2005 and 2006-2011 the most pronounced increase was for those aged 61-70 years at diagnosis; RSR changed from 0.16 (95% confidence interval (CI): 0.13-0.19) to 0.28 (95% CI: 0.23-0.33), respectively. The LEL for males aged 35 years at diagnosis was 41.0 (95% CI: 40.1-41.8) years in 1975 and 19.5 (95% CI: 16.4-22.5) years in 2011. For males aged 65 years, the corresponding figures were 13.8 (95% CI: 13.7-14.0) and 12.0 (95% CI: 11.3-12.8). Conditional LEL estimates suggested that patients who survive 5 years postdiagnosis have shorter remaining lifespan than the general population. The proportion of expected life lost (PELL) suggested that male 65-year-old patients lost 75% of their life expectancy in 2005 and 66% if they were diagnosed in 2011. Survival continued to increase to 2011, with larger improvements in those aged 61-70 years at diagnosis. The LEL and PELL are intuitive measures that may be useful in communicating survival statistics to patients, clinicians and health-care providers.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Female
- History, 20th Century
- History, 21st Century
- Humans
- Incidence
- Infant
- Infant, Newborn
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/history
- Leukemia, Myeloid, Acute/mortality
- Life Expectancy
- Male
- Middle Aged
- Population Surveillance
- Registries
- Spatio-Temporal Analysis
- Sweden/epidemiology
- Young Adult
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Affiliation(s)
- H Bower
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - T M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Björkholm
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
| | - P W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - P C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Å R Derolf
- Department of Medicine, Division of Hematology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
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26
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Autologous stem cell transplantation for adult acute leukemia in 2015: time to rethink? Present status and future prospects. Bone Marrow Transplant 2015; 50:1495-502. [PMID: 26281031 DOI: 10.1038/bmt.2015.179] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 01/22/2023]
Abstract
The use of autologous stem cell transplantation (ASCT) as consolidation therapy for adult patients with acute leukemia has declined over time. However, multiple randomized studies in the past have reported lower relapse rates after autologous transplantation compared with chemotherapy and lower non-relapse mortality rates compared with allogeneic transplantation. In addition, quality of life of long-term survivors is better after autologous transplantation than after allogeneic transplantation. Further, recent developments may improve outcomes of autograft recipients. These include the use of IV busulfan and the busulfan+melphalan combination, better detection of minimal residual disease (MRD) with molecular biology techniques, the introduction of targeted therapies and post-transplant maintenance therapy. Therefore, ASCT may nowadays be reconsidered for consolidation in the following patients if and when they reach a MRD-negative status: good- and at least intermediate-1 risk acute myelocytic leukemia in first CR, acute promyelocytic leukemia in second CR, Ph-positive acute lymphocytic leukemia. Conversely, patients with MRD-positive status or high-risk leukemia should not be considered for consolidation with ASCT.
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27
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Patient-reported quality of life after allogeneic hematopoietic cell transplantation or chemotherapy for acute leukemia. Bone Marrow Transplant 2015; 50:1241-9. [PMID: 26076127 DOI: 10.1038/bmt.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 01/13/2023]
Abstract
When discussing treatment options for patients with acute leukemia, it is important to acknowledge the impact of allogeneic hematopoietic cell transplantation (allo-HCT) or chemotherapy on quality of life (QOL). We performed a cross-sectional questionnaire study that administered SF-36, FACT-Leukemia and EuroQOL5D to 524 acute leukemia survivors, to compare patient-reported QOL between chemotherapy and allo-HCT, and to elucidate predictors of QOL. Patients who received chemotherapy alone had a better physical QOL than those who received allo-HCT. On the other hand, the allo-HCT group reported a better mental QOL. In the comparison of QOL in the allo-HCT patients according to the presence of GVHD at survey, patients who had GVHD symptoms experienced statistically and clinically significantly worse QOL than those who did not. In the allo-HCT patients without GVHD, the physical QOL was comparable to that in the chemotherapy patients, and they experienced significantly better mental and general QOL than the chemotherapy patients. GVHD and immunosuppressive drugs at survey were strongly associated with worse QOL after allo-HCT. In the chemotherapy group, a shorter time between treatment completion and survey was significantly associated with worse QOL. Further evaluation of QOL by a longitudinal assessment with quantitative and qualitative analyses are warranted.
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28
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Morishita S, Kaida K, Yamauchi S, Wakasugi T, Ikegame K, Kodama N, Ogawa H, Domen K. Early-phase differences in health-related quality of life, psychological status, and physical function between human leucocyte antigen-haploidentical and other allogeneic haematopoietic stem cell transplantation recipients. Eur J Oncol Nurs 2015; 19:443-50. [PMID: 25911269 DOI: 10.1016/j.ejon.2015.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE This study investigated the differences between allogeneic haematopoietic stem cell transplantation (allo-HSCT) patients receiving HSC from human leucocyte antigen (HLA)-haploidentical donors (HID) and other donors that included HLA-matched sibling, matched unrelated, and unrelated umbilical cord blood donors in the 6 weeks after HSCT with respect to quality of life (QOL), psychological status, and physical function. METHODS The study included 126 patients (HID group, n = 100; other donor group, n = 26) who underwent allo-HSCT between July 2007 and December 2012. Patients were evaluated for health-related QOL using the Medical Outcome Study 36-item Short Form Health Survey. Psychological status was measured by Hospital Anxiety and Depression Scale. Physical function was assessed using tests for handgrip strength, knee extensor strength, and the 6-min walk test. RESULTS After HSCT, the HID group showed significantly greater improvements in the general health subscale and Mental Component Summary (MCS) of QOL than the other donor group (P < 0.01). Multivariate analysis confirmed that complete remission and age were associated with changes in the general health subscale before and after HSCT (P < 0.05). With regard to physical function, the HID group showed significantly more decline than the other donor group with respect to handgrip strength and knee extensor muscle strength after HSCT (P < 0.05). Total corticosteroid dose was associated with decreased handgrip strength before and after HSCT (P < 0.05). CONCLUSIONS The donor type affects QOL, psychological status, and physical function in allo-HSCT recipients; these findings may provide insights for customised rehabilitation strategies for HSCT recipients.
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Affiliation(s)
- Shinichiro Morishita
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Katsuji Kaida
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Shinya Yamauchi
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Tatsushi Wakasugi
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.
| | - Kazuhiro Ikegame
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Hiroyasu Ogawa
- Division of Haematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
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29
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Jeon M, Yoo IY, Kim S, Lee J. Post-traumatic growth in survivors of allogeneic hematopoietic stem cell transplantation. Psychooncology 2014; 24:871-7. [PMID: 25382562 DOI: 10.1002/pon.3724] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 10/12/2014] [Accepted: 10/15/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to understand factors related to post-traumatic growth (PTG) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT), building baseline data for developing intervention programs to enhance PTG in HSCT survivors. METHODS A self-report survey was administered to 100 patients who received HSCT within the last 5 years. The Post-traumatic Growth Inventory, Impact of Event Scale-Revised, Perceived Social Support Scale, and Healthcare Professional's Support Scale were used, as well as items on demographic and clinical characteristics. Standard deviations of frequency and percentage, Chi-squared test between genders, independent t-test, correlation analysis between independent variables and extent of PTG, and regression analysis were conducted. RESULTS The PTG levels of HSCT survivors were statistically significantly higher when participants were women, carried out more religious activities, had higher educational levels, or utilized nurse counseling. The 'intrusive thinking' traumatic impact subcategory, as well as social support and support from healthcare professionals, were found to be highly related to PTG scores. Upon multiple regression analysis, factors with greatest influence on PTG in HSCT survivors were support from healthcare professionals, followed in order, by social support, utilization of nurse counseling, intrusive thinking, and frequency of religious activities. CONCLUSIONS We suggest implementing programs for HSCT patients to enhance support from healthcare professionals and to increase post-traumatic growth through greater utilization of nurse counseling, self-help meetings, and writing.
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Affiliation(s)
- Mijin Jeon
- Department of Hematology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Il Young Yoo
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, South Korea
| | - Sue Kim
- College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul, South Korea
| | - Jehwan Lee
- Department of Hematology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea
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30
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 PMCID: PMC4163090 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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31
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El-Jawahri A, Pidala J, Inamoto Y, Chai X, Khera N, Wood WA, Cutler C, Arora M, Carpenter PA, Palmer J, Flowers M, Weisdorf D, Pavletic S, Jaglowski S, Jagasia M, Lee SJ, Chen YB. Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20:1341-8. [PMID: 24813171 PMCID: PMC4127362 DOI: 10.1016/j.bbmt.2014.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/01/2014] [Indexed: 11/22/2022]
Abstract
Although older patients undergoing allogeneic hematopoietic stem cell transplantation (HCT) may experience higher morbidity, the impact of chronic graft-versus-host disease (GVHD) on quality of life (QOL) and survival outcomes for older compared with younger patients is currently unknown. We utilized data of patients with moderate or severe chronic GVHD (N = 522, 1661 follow-up visits, a total of 2183 visits) from the Chronic GVHD Consortium, a prospective observational multicenter cohort. We examined the relationship between age group (adolescent and young adult, "AYA," 18 to 40 years; "middle-aged," 41 to 59 years; and "older," ≥ 60 years) and QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation [FACT-BMT]), physical functioning (Human Activity Profile [HAP]), functional status (2-minute walk test [2MWT]), nonrelapse mortality, and overall survival. Because of multiple testing, P values < .01 were considered significant. This study included 115 (22%) AYA, 279 (53%) middle-aged, and 128 (25%) older patients with moderate (58%) or severe (42%) chronic GVHD. Despite more physical limitations in older patients as measured by worse functional status (shorter 2MWT [P < .001] and lower HAP scores [P < .001]) relative to AYA and middle-aged patients, older patients reported better QOL (FACT-BMT, P = .004) compared with middle-aged patients and similar to AYA patients (P = .99). Nonrelapse mortality and overall survival were similar between the age groups. Therefore, despite higher physical and functional limitations, older patients who are selected to undergo HSCT and survive long enough to develop moderate or severe chronic GVHD have preserved QOL and similar overall survival and nonrelapse mortality when compared with younger patients. Therefore, we did not find evidence that older age is associated with worse outcomes in patients with moderate or severe chronic GVHD.
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Affiliation(s)
- Areej El-Jawahri
- Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Joseph Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yoshi Inamoto
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xiaoyu Chai
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona
| | - William A Wood
- Linenberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Corey Cutler
- Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mukta Arora
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jeanne Palmer
- Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mary Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel Weisdorf
- Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota
| | - Steven Pavletic
- National Cancer Institute, National Institutes of Health Center for Cancer Research, Bethesda, Maryland
| | - Samantha Jaglowski
- Division of Hematology-Oncology, Ohio State University Medical Center, Columbus, Ohio
| | - Madan Jagasia
- Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yi-Bin Chen
- Division of Bone Marrow Transplantation, Massachusetts General Hospital Cancer Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Leunis A, Redekop WK, Uyl-de Groot CA, Löwenberg B. Impaired health-related quality of life in acute myeloid leukemia survivors: a single-center study. Eur J Haematol 2014; 93:198-206. [PMID: 24673368 DOI: 10.1111/ejh.12324] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the impact of acute myeloid leukemia (AML) and its treatment on health-related quality of life (HRQOL) by comparing the HRQOL of AML survivors with the HRQOL in the general population. METHODS Two HRQOL questionnaires (EQ-5D and QLQ-C30) were sent to patients diagnosed with AML between 1999 and 2011 at a single academic hospital and still alive in 2012. HRQOL in AML survivors was compared with general population reference values. Multivariate analysis was used to identify factors associated with HRQOL in AML survivors. RESULTS Questionnaires were returned by 92 of the 103 patients (89%). AML survivors reported significantly worse functioning, more fatigue, pain, dyspnea, appetite loss, and financial difficulties and lower EQ-VAS scores than the general population (P < 0.05). Impaired HRQOL in AML survivors was mainly found in survivors without a paid job. Other factors associated with a poor HRQOL were allogeneic hematopoietic stem cell transplantation and the absence of social support. CONCLUSION This single-center study showed that the HRQOL in AML survivors is worse than the HRQOL in the general population. HRQOL in these patients can be improved by adequately treating and preventing fatigue, pain, dyspnea, and appetite loss.
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Affiliation(s)
- Annemieke Leunis
- Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Cheng MJ, Hourigan CS, Smith TJ. Adult Acute Myeloid Leukemia Long-term Survivors. JOURNAL OF LEUKEMIA (LOS ANGELES, CALIF.) 2014; 2:26855. [PMID: 25243197 PMCID: PMC4167020 DOI: 10.4172/2329-6917.1000135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The number of leukemia patients and survivors is growing. This review summarizes what is known regarding the health related quality of life (HRQOL) and medical complications associated with acute myeloid leukemia (AML) disease and treatment and highlights understudied aspects of adult AML survivorship care, and potential novel areas for intervention.
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Affiliation(s)
- M Jennifer Cheng
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Christopher S Hourigan
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
| | - Thomas J Smith
- Pain and Palliative Service, Clinical Center, National Institutes of Health (MJC), National Heart, Lung, and Blood Institute, (CSH) and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland (TJS)
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de Wreede LC, Watson M, van Os M, Milligan D, van Gelder M, Michallet M, Dreger P, Dearden CE, Homewood J, Dupuis J, Leporrier M, Karas M, Corront B, Baerlocher GM, Herr W, Choquet S, Niederwieser DW, Sutton L, Kröger N, de Witte TM, Schetelig J. Improved relapse-free survival after autologous stem cell transplantation does not translate into better quality of life in chronic lymphocytic leukemia: lessons from the randomized European Society for Blood and Marrow Transplantation-Intergroup study. Am J Hematol 2014; 89:174-80. [PMID: 24123244 DOI: 10.1002/ajh.23610] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 12/21/2022]
Abstract
In chronic lymphocytic leukemia (CLL) medical progress is driven by clinical studies with relapse-free survival (RFS) as the primary endpoint. The randomized EBMT-Intergroup trial compared high-dose therapy and autologous stem cell transplantation (ASCT) to observation and demonstrated a substantial improvement of RFS without showing improved overall survival for the transplant arm. Here we report quality of life (QoL) information of the first 3 years following randomization from that study. The main objective was to assess the impact of treatment on QoL over time. Two secondary analyses were performed to further investigate the impact of ASCT and relapse on QoL. In the primary analysis, we demonstrate an adverse impact of ASCT on QoL which was largest at 4 months and continued throughout the first year after randomization. Further, we demonstrated a sustained adverse impact of relapse on QoL which worsened over time. Despite better disease control by ASCT the side effects thus turned the net effect towards inferior QoL in the first year and comparable QoL in the following 2 years after randomization. This study emphasizes the importance of information concerning QoL impacts when patients are counseled about treatments aimed at improving RFS in the absence of a survival benefit.
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Affiliation(s)
| | | | - Marleen van Os
- EBMT/Dept of Medical Statistics & Bioinformatics LUMC; Leiden The Netherlands
| | | | | | | | | | | | - Janis Homewood
- Institute of Cancer Research / Royal Marsden Hospital; Sutton United Kingdom
| | - Jehan Dupuis
- CHU Henri Mondor Assistance Publique-Hôpitaux de Paris; Creteil France
| | - Michel Leporrier
- Université de Caen Basse-Normandie & UMR 6301 ISTCT, LDM-TEP, GIP Cyceron; France
| | - Michal Karas
- Charles University Hospital; Pilsen Czech Republic
| | | | | | | | | | | | | | | | - Theo M. de Witte
- Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
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Assessing the Outcomes of a Supervised Exercise Intervention Following Recent Allogeneic Bone Marrow Transplantation: A Case Report. REHABILITATION ONCOLOGY 2014. [DOI: 10.1097/01893697-201432020-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kapucu S, Karacan Y. Physiological problems in patients undergoing autologous and allogeneic hematopoietic stem cell transplantation. Asia Pac J Oncol Nurs 2014; 1:50-54. [PMID: 27981083 PMCID: PMC5123448 DOI: 10.4103/2347-5625.135821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Stem cell transplantation is usually performed in an effort to extend the patient's life span and to improve their quality of life. This study was conducted to determine the postoperative physiological effects experienced by patients who had undergone autologous and allogeneic stem cell transplantation. METHODS The research is a descriptive study conducted with a sample of 60 patients at Stem Cell Transplantation Units in Ankara. Percentile calculation and chi-square tests were used to evaluate the data. RESULTS When a comparison was made between patients who had undergone allogeneic Hematopoietic stem cell transplantation (HSCT) and those who had undergone autologous HSCT, results indicated that problems occurred more often for the allogeneic HSCT patients. The problems included: Digestion (94.3%), dermatological (76.7%), cardiac and respiratory (66.7%), neurological (66.7%), eye (56.7%), infections (26.7%) and Graft Versus Host Disease (5 patients). Furthermore, the problems with pain (50%), numbness and tingling (40%), and speech disorders (3 patients) were observed more often in autologous BMT patients. CONCLUSION Autologous and allogeneic patients experienced most of physical problems due to they receive high doses of chemotherapy. Therefore, it is recommended that an interdisciplinary support team approach should be usedtohelp reduce and manage the problems that may arise during patient care.
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Affiliation(s)
- Sevgisun Kapucu
- Department of Internal Diseases Nursing, Hacettepe University, Faculty of Nursing, Ankara, Turkey
| | - Yasemin Karacan
- Department of Hematology, MN Uludag University, Goruklu, Bursa, Turkey
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The value of allogeneic and autologous hematopoietic stem cell transplantation in prognostically favorable acute myeloid leukemia with double mutant CEBPA. Blood 2013; 122:1576-82. [PMID: 23863898 DOI: 10.1182/blood-2013-05-503847] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The clinical value of allogeneic hematopoietic stem cell transplantation (alloHSCT) and autologous hematopoietic stem cell transplantation (autoHSCT) in the subtype of acute myeloid leukemia (AML) with double mutant CEBPA (CEBPAdm) has remained unsettled. Among 2983 patients analyzed for CEBPA mutational status (age 18-60 years) treated on 4 published Dutch-Belgian-Swiss Hemato-Oncology Cooperative Group (HOVON/SAKK) and 3 German-Austrian AML Study Group (AMLSG) protocols (2 published, 1 registered, clinicaltrials.gov NCT00151255), 124 had AML with CEBPAdm and achieved first complete remission (CR1). Evaluation of the clinical impact of alloHSCT and autoHSCT vs chemotherapy was performed by addressing time dependency in the statistical analyses. Thirty-two patients proceeded to alloHSCT from a matched related (MRD, n = 29) or a matched unrelated donor (MUD, n = 3), 20 to autoHSCT in CR1 and 72 received chemotherapy. Relapse-free survival was significantly superior in patients receiving an alloHSCT or autoHSCT in CR1 as compared with chemotherapy (P < .001), whereas overall survival was not different (P < .12). Forty-five patients relapsed. Of 42 patients treated with reinduction therapy, 35 achieved a second CR (83%) and most patients (n = 33) received an alloHSCT MRD, n = 11; MUD, n = 19; haplo-identical donor, n = 3). Survival of relapsed patients measured from date of relapse was 46% after 3 years. Adult AML patients with CEBPAdm benefit from alloHSCT and autoHSCT; relapsed patients still have a favorable outcome after reinduction followed by alloHSCT.
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Burnett AK, Goldstone A, Hills RK, Milligan D, Prentice A, Yin J, Wheatley K, Hunter A, Russell N. Curability of patients with acute myeloid leukemia who did not undergo transplantation in first remission. J Clin Oncol 2013; 31:1293-301. [PMID: 23439754 DOI: 10.1200/jco.2011.40.5977] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aims of this study were to quantify the prospects of salvage treatment of patients who did not undergo transplantation in first complete remission (CR1) and to assess the contribution of allograft in second complete remission (CR2) with respect to major risk groups. This evaluation can inform the decision whether to offer a transplant in CR1. PATIENTS AND METHODS Of 8,909 patients who entered the Medical Research Council AML10, AML12, and AML15 trials, 1,271 of 3,919 patients age 16 to 49 years who did not receive a transplant in CR1 relapsed. Of these patients, 19% are alive beyond 5 years compared with 7% of patients who relapsed after an allograft in CR1. Overall survival and the contribution of a transplant in CR2 were assessed overall and by cytogenetic risk group by using Mantel-Byar analysis. RESULTS Fifty-five percent of patients who relapsed entered CR2. This percentage varied by risk group as follows: favorable (82%), intermediate (54%), adverse (27%), and unknown (53%), which resulted in 5-year survivals of 32%, 17%, 7%, and 23%, respectively. Sixty-seven percent of remitters received an allotransplant that delivered superior survival compared with patients who did not receive a stem-cell transplant (42% v 16%). A more-stringent assessment of a transplant by using delayed-entry (Mantel-Byar) analysis confirmed the benefit of transplant overall and within intermediate and adverse risk groups but not the favorable subgroup. CONCLUSION Successful salvage treatment of patients who do not undergo transplantation in CR1 and relapse can be achieved in 19% of patients, which is improved by a transplant except in favorable risk disease. This result suggests that, for intermediate-risk patients in particular, equivalent overall survival can be achieved by delaying transplantation until after relapse, which would require many fewer transplants.
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Affiliation(s)
- Alan K Burnett
- Department of Haematology, Cardiff University School of Medicine, Heath Park, Cardiff, UK.
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Parry C, Lomax JB, Morningstar EA, Fairclough DL. Identification and correlates of unmet service needs in adult leukemia and lymphoma survivors after treatment. J Oncol Pract 2012; 8:e135-41. [PMID: 23277776 PMCID: PMC3439239 DOI: 10.1200/jop.2011.000464] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine and characterize the psychosocial and health service needs of adult leukemia and lymphoma survivors who had completed active treatment within the past 4 years. METHODS Self-report surveys were completed by 477 survivors, age 18 to 85 years, to identify areas and correlates of unmet psychosocial, health, and instrumental service needs. Unmet service needs were rank ordered, and nonparametric tests were run to assess relationships. RESULTS The rate of unmet need was highest regarding sexual issues, handling medical and living expenses, emotional difficulties, employment, and health insurance. Women were more likely to report unmet child care needs than men; younger individuals were more likely to report needing help with emotional difficulties and family problems; and lower income was related to greater unmet need regarding medical and living expenses. Relationships were also observed among the service needs, suggesting overlapping areas of unmet need. CONCLUSION Adult leukemia and lymphoma survivors demonstrated a diverse range of needs, many of which were related to the psychosocial and physical sequelae of cancer. The findings suggest directions for service provision and development of standards for quality care in this underserved post-treatment population.
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Affiliation(s)
- Carla Parry
- University of Colorado Denver School of Medicine, Aurora, CO, USA.
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Abstract
Hematopoietic stem cell transplantation is a highly expensive clinical intervention with considerable therapeutic benefit but serious adverse effects on health status in some circumstances. Consequently, it is an important target for economic evaluation in which the monetary costs and clinical consequences of optional treatment strategies are compared. The need for such formal assessment is further demanded by the expanded use of hematopoietic stem cell transplantation globally, including its utilization in developing countries. With respect to costs, those incurred by patients and families are often substantial, while those incurred by hospitals may be inadequately reimbursed. Determination of consequences should not be limited to measurements of clinical effectiveness but rather include adjustments for quality of life. Rigorous economic evaluation can provide hard evidence in deliberations of value for money, especially in the context of limited resources for health care.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, 1280 Main St West, Hamilton, Ont. L8S 4K1, Canada.
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Zareifar S, Farahmandfar MR, Cohan N, Modarresnia F, Haghpanah S. Evaluation of health related quality of life in 6-18 years old patients with acute leukemia during chemotherapy. Indian J Pediatr 2012; 79:177-82. [PMID: 21638073 DOI: 10.1007/s12098-011-0483-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 05/03/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the quality of life (QOL) of Iranian children with acute leukemia during chemotherapy. METHODS One hundred patients between 6 to 18-years-old were selected by convenient sampling method. EORTC QLQ-C30 Questionnaire was completed by their parents' help. Demographic information such as age, sex and type of leukemia were also collected. These data were evaluated by SPSS software, Chi-square and independent sample T test. The relation between different scales of questionnaire and variables was measured and final results were compared with reference values. RESULTS In acute Lymphoblastic Leukemia patients QOL, physical and cognitive functions were lower in comparison with acute myelogenous leukemia and they had more fatigue, pain and insomnia. The patients between ages of 12-18-years-old had more financial difficulties and diarrhea and lower cognitive function in comparison with 6-12-years-old patients. The present patients achieved higher scores than reference value, but they had more economic problem. CONCLUSIONS The patients had relatively good QOL. The lowest impression was in cognitive function and the highest was in emotional function. The patients mostly complained of financial difficulties and fatigue and rarely of diarrhea and constipation. It is necessary to do more researches related to health related QOL in pediatric patients.
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Affiliation(s)
- Soheila Zareifar
- Hematology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Klusmann JH, Reinhardt D, Zimmermann M, Kremens B, Vormoor J, Dworzak M, Creutzig U, Klingebiel T. The role of matched sibling donor allogeneic stem cell transplantation in pediatric high-risk acute myeloid leukemia: results from the AML-BFM 98 study. Haematologica 2011; 97:21-9. [PMID: 21933851 DOI: 10.3324/haematol.2011.051714] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of allogeneic stem cell transplantation in post-remission management of children with high-risk acute myeloid leukemia remains controversial. In the multi-center AML-BFM 98 study we prospectively evaluated the impact of allogeneic stem cell transplantation in children with high-risk acute myeloid leukemia in first complete remission. DESIGN AND METHODS HLA-typed patients with high-risk acute myeloid leukemia, who achieved first complete remission (n = 247), were included in this analysis. All patients received double induction and consolidation. Based on the availability of a matched-sibling donor, patients were allocated by genetic chance to allogeneic stem cell transplantation (n = 61) or chemotherapy-only (i.e. intensification and maintenance therapy; n = 186). The main analysis was done on an intention-to-treat basis according to this allocation. RESULTS Intention-to-treat analysis did not show a significantly different 5-year disease-free survival (49 ± 6% versus 45 ± 4%, P(log rank) = 0.44) or overall survival (68 ± 6% versus 57 ± 4%, P(log rank) = 0.17) between the matched-sibling donor and no-matched-sibling donor groups, whereas late adverse effects occurred more frequently after allogeneic stem cell transplantation (72.5% versus 31.8%, P(Fischer)<0.01). These results were confirmed by as-treated analysis corrected for the time until transplantation (5-year overall survival: 72 ± 8% versus 60 ± 4%, P(Mantel-Byar) 0.21). Subgroup analysis demonstrated improved survival rates for patients with 11q23 aberrations allocated to allogeneic stem cell transplantation (5-year overall survival: 94 ± 6% versus 52 ± 7%, P(log-rank) = 0.01; n = 18 versus 49) in contrast to patients without 11q23 aberrations (5-year overall survival: 58 ± 8% versus 55 ± 5%, P(log-rank) = 0.66). CONCLUSIONS Our analyses defined a genetic subgroup of children with high-risk acute myeloid leukemia who benefited from allogeneic stem cell transplantation in the prospective multi-center AML-BFM 98 study. For the remainder of the pediatric high-risk acute myeloid leukemia patients the prognosis was not improved by allogeneic stem cell transplantation, which was, however, associated with a higher rate of late sequelae.
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Affiliation(s)
- Jan-Henning Klusmann
- Department of Pediatric Hematology and Oncology University Children's Hospital Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Saini L, Alibhai SMH, Brandwein JM. Quality of life issues in elderly acute myeloid leukemia patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The median age of acute myeloid leukemia (AML) is 70 years. Treatment approaches include standard chemotherapy, palliative chemotherapy and investigational agents, depending upon disease biology and patient factors. In this article, we highlight the issues involved in the treatment of AML in older patients, focusing on the quality of life changes associated with each treatment modality at different stages of their disease course. We further discuss recent insights into the biological basis of quality of life changes, and examine potential ways to improve these through pharmacological and nonpharmacological means. Finally, we explore avenues for future research into the quality of life of the older AML patient.
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Affiliation(s)
- Lalit Saini
- Department of Medical Oncology & Hematology, Princess Margaret Hospital, 610 University Avenue, Rm. 5–109, Toronto, ON M5G 2M9, Canada
| | - Shabbir MH Alibhai
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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Grulke N, Albani C, Bailer H. Quality of life in patients before and after haematopoietic stem cell transplantation measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire QLQ-C30. Bone Marrow Transplant 2011; 47:473-82. [PMID: 21602898 DOI: 10.1038/bmt.2011.107] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The EORTC Quality of Life Core Questionnaire QLQ-C30 is widely used, but no reference values are available for patients receiving HSCT. We retrieved data for 38 samples from 33 papers in English and German that provided evaluable information on QLQ-C30 scores (mean, s.d.) covering about 2800 patients. Results are presented as a table that provides reference data that allow QLQ-C30 scores at different points during the disease trajectory to be put in context. With respect to their central tendency and their variance, scores vary over time. Quality of life is lowest during inpatient time. About 1 year after HSCT, the pre-transplant level is reached. Physical functioning is the scale reaching the highest level of all scales. Fatigue, dyspnoea and insomnia are symptoms that remain at an elevated level and should thus be considered as persisting problems after HSCT. For the interpretation of differences between scores, a very conservative recommendation would be to set the s.d. at 30 points. Doing so, one could be quite sure of having found a clinically significant change if the difference of two scores exceeds 15 points. Differences below 5 points should be interpreted with caution.
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Affiliation(s)
- N Grulke
- Luisenklinik-Zentrum für Verhaltensmedizin, Bad Dürrheim, Germany
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Bevans MF, Mitchell SA, Barrett AJ, Bishop M, Childs R, Fowler D, Krumlauf M, Prince P, Shelburne N, Wehrlen L. Function, adjustment, quality of life and symptoms (FAQS) in allogeneic hematopoietic stem cell transplantation (HSCT) survivors: a study protocol. Health Qual Life Outcomes 2011; 9:24. [PMID: 21496339 PMCID: PMC3101119 DOI: 10.1186/1477-7525-9-24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 04/17/2011] [Indexed: 11/20/2022] Open
Abstract
Background The population of survivors following allogeneic HSCT continues to increase, and yet their experiences of recovery and long-term survivorship have not been fully characterized. This paper presents a study protocol examining over time the functional status, psychosocial adjustment, health-related quality of life, and symptom experience of survivors who have undergone allogeneic transplantation. The aims of the study are to: 1) explore the patterns of change in these health outcomes during the survivorship phase; 2) characterize subgroups of survivors experiencing adverse outcomes; and 3) examine relationships among outcomes and demographic and clinical factors (such as age, graft-versus-host disease (GVHD), and disease relapse). Methods In this longitudinal observational study, adults who survive a minimum of 3 years from date of allogeneic transplantation complete a series of questionnaires annually. Demographic and clinical data are collected along with a series of patient-reported outcome measures, specifically: 1) Medical Outcomes Study SF- 36; 2) Functional Assessment of Chronic Illness Therapy (FACIT) - General, 3) FACIT-Fatigue; 4) FACIT- Spiritual; 5) Psychosocial Adjustment to Illness Scale; 6) Rotterdam Symptom Checklist-Revised; and 7) Pittsburgh Sleep Quality Index. Conclusions This study will provide multidimensional patient-reported outcomes data to expand the understanding of the survivorship experience across the trajectory of allogeneic transplantation recovery. There are a number of inherent challenges in recruiting and retaining a diverse and representative sample of long-term transplant survivors. Study results will contribute to an understanding of outcomes experienced by transplant survivors, including those with chronic GVHD, malignant disease relapse, and other late effects following allogeneic transplantation. Trial Registration ClinicalTrials.gov: NCT00128960
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ANDERSSON I, AHLBERG K, STOCKELBERG D, PERSSON LO. Patients' perception of health-related quality of life during the first year after autologous and allogeneic stem cell transplantation. Eur J Cancer Care (Engl) 2011; 20:368-79. [DOI: 10.1111/j.1365-2354.2009.01174.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Wingard JR, Huang IC, Sobocinski KA, Andrykowski MA, Cella D, Rizzo JD, Brady M, Horowitz MM, Bishop MM. Factors associated with self-reported physical and mental health after hematopoietic cell transplantation. Biol Blood Marrow Transplant 2010; 16:1682-92. [PMID: 20685400 DOI: 10.1016/j.bbmt.2010.05.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 05/25/2010] [Indexed: 10/19/2022]
Abstract
Hematopoietic cell transplantation (HCT) is an intensive treatment for hematologic malignancies that has the potential to cure disease or prolong life, but also to impair quality of life for survivors. Earlier studies have suggested that various factors are associated with physical and mental health after HCT. In this study, we evaluated demographic and clinical factors before and after HCT and selected psychosocial factors after HCT, exploring their association with self-reported physical and mental health. We studied a cohort of 662 survivors at a median of 6.6 years after HCT. Pre-HCT demographic and clinical factors accounted for only a small amount of the variance in physical and mental health post-HCT (3% and 1%, respectively). Adding post-HCT clinical variables to the pre-HCT factors accounted for 32% and 7% of physical and mental outcomes, respectively. When both clinical and psychosocial factors were considered, better physical health post-HCT was associated with younger age, race other than white, higher current family income, currently working or being a student, less severe transplantation experience (ie, not experiencing graft-versus-host disease), fewer current comorbidities, higher Karnofsky status, less social constraint, less social support, and less trait anxiety. This multivariate model accounted for 36% of the variance in physical health, with the psychosocial variables contributing very little. When both clinical and psychosocial factors were considered, better mental health after HCT was associated with more severe transplantation experience, less social constraint, greater spiritual well being, and less trait anxiety. This multivariate model accounted for 56% of the variance in mental health, with the psychosocial factors accounting for most of the variance. These data suggest that clinical factors are explanatory for much of the post-HCT physical health reported by HCT survivors, but very little of self-perceived mental health. These observations provide insight into the identification of factors that can allow recognition of at-risk patients, as well as factors amenable to intervention.
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Affiliation(s)
- John R Wingard
- Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0278, USA.
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Wong FL, Francisco L, Togawa K, Bosworth A, Gonzales M, Hanby C, Sabado M, Grant M, Forman SJ, Bhatia S. Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns. Blood 2010; 115:2508-19. [PMID: 20089962 PMCID: PMC2845903 DOI: 10.1182/blood-2009-06-225631] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 12/30/2009] [Indexed: 02/08/2023] Open
Abstract
This prospective longitudinal study examined the quality of life (QOL) after hematopoietic cell transplantation (HCT) and identified risk factors of poor QOL in 312 adult autologous and allogeneic HCT patients. Physical, psychological, social, and spiritual well-being was assessed before HCT, 6 months, and 1, 2, and 3 years after HCT. For all HCT patients, physical QOL was stable from before to after HCT (P > .05); psychologic (P < .001), social (P < .001), and spiritual (P = .03) QOL improved at 6 months. Study noncompleters (because of illness or death) had worse QOL. Allogeneic patients reported worse physical and psychologic well-being (P < .05). Older patients reported worse physical but better social well-being regardless of HCT type (P < .05). Two or more domains were affected by race/ethnicity, household income, and education in autologous patients, and by body mass index (BMI), decline in BMI, primary diagnosis, and chronic graft-versus-host disease (GVHD) in allogeneic patients (P < .05). At 3 years, 74% of HCT patients were employed full or part time. Older autologous patients with lower pre-HCT income were less likely to work (P < .05); allogeneic patients with chronic GVHD were less likely to work (P = .002). Multidisciplinary efforts to identify and support vulnerable subgroups after HCT need to be developed.
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Affiliation(s)
- F Lennie Wong
- Population Sciences, City of Hope National Medical Center, Duarte, CA 91010-3000, USA.
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Abstract
Leukemia represents the most common pediatric malignancy, accounting for approximately 30% of all cancers in children less than 20 years of age. Most children diagnosed with leukemia are cured without hematopoietic stem cell transplantation (HSCT), but for some high-risk subgroups, allogeneic HSCT plays an important role in their therapeutic approach. The characteristics of these high-risk subgroups and the role of HSCT in childhood leukemias are discussed.
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Affiliation(s)
- Alan S. Wayne
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health Building 10, Room 1-3750, 9000 Rockville Pike, MSC 1104, Bethesda, MD 20892-1104, Tel: 301-496-4256,
| | - Kristin Baird
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health Building 10, Room 1-3750, 9000 Rockville Pike, MSC 1104, Bethesda, MD 20892-1104, Tel: 301-496-4256
| | - R. Maarten Egeler
- Department of Pediatrics/BMT Unit, Leiden University Medical Center, Postbus 9600, 2300 RC, Leiden, The Netherlands, Tel: +31-71-526-2166,
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Zhang L, Tong Z, Li S, Ren X, Ren B, Wang X, Cao S, Wang C, He L. Quality of Life after Autologous Peripheral Blood Stem Cell Transplantation and High-Dose Chemotherapy in High-Risk Breast Cancer Patients. ACTA ACUST UNITED AC 2009; 4:379-386. [PMID: 20877673 DOI: 10.1159/000266759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND: As long-term survivors of breast cancer after autologous peripheral blood stem cell transplantation (ASCT) are becoming more numerous, studies addressing the issue of long-term follow-up are necessary. In this study, we report on the quality of life (QOL) after ASCT and high-dose chemotherapy (HDCT). PATIENTS AND METHODS: The QOL questionnaire version 3.0 by the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30 version 3.0) was filled in by patients and healthy controls at 5 time points. After obtaining the results, we analyzed the correlation between QOL and the effect factors. RESULTS: Some functions got significantly worse, and some symptoms got more serious after ASCT and HDCT. However, most of them improved with time and were comparable to the healthy controls after 5 years. QOL was in part related to age, tumor characteristics, educational level, marriage status, and income. CONCLUSIONS: Evaluating QOL allows medical workers to fully understand a patient's state of health, and aid the estimation and selection of clinical treatment methods as well as improve recovery.
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Affiliation(s)
- Li Zhang
- Medical Department of Breast Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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