Symptom burden in patients undergoing autologous stem-cell transplantation

Abstract

Patients who undergo autologous peripheral blood stem cell (PBSC) transplantation experience multiple symptoms that adversely affect quality of life. We assessed symptoms during the acute phase of autologous PBSC transplantation to determine the severity of individual symptoms and to determine overall symptom profiles in 100 patients with multiple myeloma or non-Hodgkin's lymphoma. Study subjects completed the blood and marrow transplantation module of the M. D. Anderson Symptom Inventory before hospitalization, during conditioning, on day of transplantation, at nadir (the time of lowest white blood cell count) and on day 30 posttransplantation. Additional symptom, quality-of-life and medical status measures were collected. Symptom means were mild at baseline, intensified during conditioning, peaked at nadir and decreased by day 30. At nadir, the most severe symptoms for the entire patient sample were lack of appetite, fatigue, weakness, feeling sick, disturbed sleep, nausea and diarrhea. Cancer diagnosis was a significant predictor of changes in symptoms over time. The patterns of fatigue, pain, sleep disturbance and lack of appetite were significantly different for patients with multiple myeloma as compared with patients with nonHodgkin's lymphoma.

Sleep Disruption in Hematopoietic Cell Transplantation Recipients: Prevalence, Severity, and Clinical Management

“…At the time of hospital discharge, the average severity of sleep disruption among allogeneic and autologous patients was still moderately elevated relative to baseline symptomatology (i.e., .51 SD) (26). Nevertheless, it appears that increases in sleep disruption are generally transient; by day 100, sleep disruption returns to levels comparable to pre-HCT (4, 25, 31), although these levels are substantially elevated even before the transplant. Patients receiving allogeneic HCT demonstrate similar levels of sleep disruption near day 100 to patients receiving autologous transplant (4).…”

“…Of these, 9 studies did not provide estimates of prevalence of sleep disruption or comparisons to individuals not receiving HCT (7, 23-30). The remaining 7 studies are heterogeneous in terms of their sample composition, sample size, measure of sleep, and clinical cutoff (3, 4, 31-35). Thus, it is not surprising that there is substantial heterogeneity among study findings.…”

“…Thus, it is not surprising that there is substantial heterogeneity among study findings. Studies utilizing single-item measures of sleep disruption suggest that approximately 8% of autologous patients report moderate to severe sleep disruption (31) while more than 50% of allogeneic patients report sleep disruption of any severity (3). In contrast, the two studies using validated measures [i.e., PSQI, ESS] found that 32% of patients reported clinically-significant sleep disruption before autologous or allogeneic transplant (4) and 43% of multiple myeloma patients reported clinically-significant daytime sleepiness before autologous transplant (35).…”

“…Available data suggest that sleep disruption was the most distressing symptom among allogeneic HCT recipients at day 0 and was significantly correlated with bowel changes and fatigue (3). Sleep disruption significantly increased during the first 100 days, with greatest disruption seen during the conditioning regimen and white blood cell count nadir (31). Mean changes of 27 points on the EORTC QLQ-C30 sleep disruption item were observed from pre-transplant baseline to its peak approximately two weeks post-HCT (25), corresponding to a large increase and effect size of 1.1 standard deviations (SD) (25).…”

Symptoms and Quality of Life in Diverse Patients Undergoing Hematopoietic Stem Cell Transplantation

“…10,11 Campagnaro et al 11 used the M. D. Anderson Symptom Inventory (MDASI), and Anderson et al 10 used the MDASI Blood and Marrow Transplantation (MDASI-BMT) module. Both studies found that symptoms intensified throughout transplantation and decreased by Day 30.…”