Pain in older survivors of hematologic malignancies after blood or marrow transplantation: A BMTSS report

Abstract

BACKGROUND: Blood or marrow transplantation (BMT) is increasingly offered to older adults with hematologic malignancies; however, their risk for severe pain is poorly understood. Using the Bone Marrow Transplant Survivor Study, the current study investigated the prevalence and predictors of pain after BMT (allogeneic or autologous) as well as its association with physical performance impairments and frailty. METHODS: The cohort included 736 patients with hematologic malignancies who underwent BMT at an age ≥ 60 years at 1 of 3 transplant centers between 1974 and 2014 and survived ≥2 years after BMT; 183 unaffected siblings also participated. Study participants reported on 4 pain domains (nonminor everyday pain, moderate to severe bodily pain, prolonged pain, and moderate to extreme pain interference), and the presence of 1 or more domains was indicative of a severe and/or life-interfering pain composite variable. RESULTS: Overall, 39.4% of the BMT survivors reported severe pain with 2.6-fold greater odds of reporting pain in comparison with sibling controls. Among BMT recipients, those with less education, lower incomes, and active chronic graft-versus-host disease had higher odds of reporting pain. In multivariable analyses, BMT survivors with pain were more likely to have impaired physical performance and were more likely to meet the frailty criteria. BMT survivors reported higher use of pain medications (17.8% vs 9.3%) and opioid pain medications (6.5% vs 2.2%) in comparison with sibling controls. CONCLUSIONS: Nearly 40% of older BMT survivors who were followed for a median of 5 years after BMT reported pain, and BMT survivors had 2.6-fold higher odds of reporting severe, nonminor or life-interfering pain in comparison with siblings.

Feasibility and preliminary efficacy of the Balance Program to reduce pain‐related disability in pediatric sickle cell disease

“…For example, hospitalization rates for pediatric SCD have remained largely unchanged from 2000 to 2016, 46 with pain being the primary reason for hospital admissions 46,47 . Additionally, a subset of patients who receive curative therapies, such as hematopoietic stem cell transplant, continue to experience pain following transplant 48,49 . Although NHLBI and ASH recognize the need for nonpharmacological pain management in SCD, 17–19 there are no standard behavioral treatment guidelines with limited options for behavioral interventions that specifically address SCD‐related pain and associated functional impairment.…”

Feasibility of implementing a supervised telehealth exercise intervention in frail survivors of hematopoietic cell transplantation: a pilot randomized trial

“…Study participants were identified from the Blood or Marrow Transplant Survivor Study (BMTSS), which is a retrospective cohort study of patients who received HCT at City of Hope (COH), University of Minnesota, or University of Alabama at Birmingham (UAB) for hematologic malignant diseases, or severe aplastic anemia, and survived at least 2 years after HCT [ 3 , 21 , 22 ]. Eligibility requirements for the current trial included: 1) ≥ 18 years of age at the time of study enrollment; 2) ≥ 2 years from HCT and in clinical remission; 3) self-reported as pre-frail or frail on the BMTSS questionnaire using the following criteria: clinically underweight (body mass index < 18.5 kg/m 2 ); exhaustion (self-report of feeling tired); low energy expenditure (self-report of physical activity for < 2 days/week); slowness (self-reported limitations in climbing stairs or walking 1 block); and weakness (self-report of weakness in movement), with the presence of 2 of the indices classified as prefrail and ≥ 3 indices classified as frail [ 3 ]; 4) able to provide written informed consent; 5) physically able and willing to complete all study procedures; 6) English-speaking.…”