Quality of Life after Allogeneic Hematopoietic Cell Transplantation According to Affected Organ and Severity of Chronic Graft-versus-Host Disease

Abstract

Knowing the impact of chronic graft-versus-host disease (GVHD) on quality of life (QoL) after allogeneic hematopoietic stem cell transplantation (allo-HCT) by GVHD type and severity is critical for providing care to transplant survivors. We conducted a cross-sectional questionnaire study to examine the relationship between patient-reported QoL as measured by the Medical Outcomes Study 36-Item Short-Form Health Survey, Functional Assessment of Cancer Therapy-Bone Marrow Transplant, and visual analogue scale (VAS) and chronic GVHD defined by the National Institutes of Health (NIH) criteria. Recipients of allo-HCT for hematologic disease between 1995 and 2009 aged ≥ 16 years at transplant and ≥20 years at the time of the survey who were relapse-free were eligible. A total of 1140 pairs of patient and physician questionnaires were included in the analysis. By NIH global severity score, QoL scores in all aspects were significantly lower in patients with higher global and organ-specific severity grades, independent of background variables. Compared with patients without GVHD symptoms, those with mild symptoms had impaired physical and general QoL according to global severity score and organ-specific scores except for the genital tract. Mild symptoms in the lungs, gastrointestinal tract, and joints and fascia were associated with clinically meaningful deterioration of physical QoL. VAS scores provided by physicians were generally higher than those provided by patients. Differences between scores reported by patients and physicians were larger for patients with no or mild GVHD symptoms. Our findings based on more than 1000 long-term survivors after HCT enabled us to identify a target of care, informing survivorship care protocols to improve post-transplantation QoL.

Evaluation of cardiopulmonary exercise testing, heart function, and quality of life in children after allogenic hematopoietic stem cell transplantation

“…QOL has been investigated by several groups with different results: some authors found no effect on long‐term QOL or health, whereas others found diminished QOL in children suffering from health conditions or cancer‐related pain . It is known that parents report lower QOL of their children compared with child‐report QOL .…”

Refractory Graft-Versus-Host Disease–Free, Relapse-Free Survival as an Accurate and Easy-to-Calculate Endpoint to Assess the Long-Term Transplant Success

“…Chronic GVHD is a major cause of morbidity and mortality after allo-HSCT and occurs in approximately 30% to 70% of the recipients. In addition, it impairs QOL in long-term survivors [2][3][4][5]. To reflect all of these events in a single survival curve, GRFS is widely used in clinical studies [1].…”

“…Recently, graft-versus-host disease (GVHD)free, relapse-free survival (GRFS), defined as the absence of grade III to IV acute GVHD, chronic GVHD requiring systemic treatment, relapse, or death, was proposed as a novel composite endpoint for clinical trials evaluating GVHD prophylaxis after allo-HSCT [1]. GRFS is now widely used to evaluate the success of allo-HSCT, as chronic GVHD is associated with impaired QOL [2][3][4][5]. However, this conventional GRFS treats GVHD as a fixed failure event, similar to relapse or death, even though GVHD may be resolved by treatment.…”

Effects of Low-Dose Glucocorticoid Prophylaxis on Chronic Graft-versus-Host Disease and Graft-versus-Host Disease–Free, Relapse-Free Survival after Haploidentical Transplantation: Long-Term Follow-Up of a Controlled, Randomized Open-Label Trial

“…chronic GVHD and ONFH, which adversely affect quality of life [39,40,42]. Concerning the effects of prophylactic corticosteroid administration on survival [7,9À11,17,19], Deeg et al [7] did not observe a long-term survival advantage for the addition of MP to CSA after a median follow-up of 6 years.…”