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Background: Health-related quality of life (QOL) is an important issue in post-transplant care of long-term survivors after hematopoietic stem cell transplantation (HSCT). We conducted a single-center cross-sectional analysis of medical and socio-demographic factors affecting on the QOL outcomes in HSCT recipients.
Patients and Methods: This analysis included 152 Japanese adult patients surviving more than 2 years after allogeneic HSCT in Toranomon Hospital, who were enrolled at a median of 5.4(2.0-18.4) years from HSCT. Patient-reported QOL was assessed using two questionnaires (FACT-BMT and SF-36), and physical exams and laboratory tests for screening post-transplant complications were principally performed at the time of QOL survey completion. Chronic graft-versus-host disease (cGVHD) severity was determined by NIH consensus criteria. Socio-demographic data was collected through self-report and chart review.
Results: The median age at enrollment was 55 (23-75) years old. Thirty-eight patients received related donor grafts, while 58 and 56 received unrelated cord blood and bone marrow. One hundred received reduced-intensity conditioning. cGVHD were observed in 127 patients (severe in 17, moderate in 65, mild in 45), the most commonly involved organ of which was eyes (51.3%), followed by skin (50%) and mouth (34.9%). Forty-six patients had other late complications (endocrine disorders in 9, bone events in 22, ocular events in 22, and secondary malignancies in 5). The differences according to interval from HSCT were not seen in all composite score and subscales of the two questionnaires except physical well-being score (PWB) of the FACT-BMT during the late post-transplant period. Although the FACT-BMT total score was not significantly different between patients who had any cGVHD and those who did not, it progressively decreased with increasing cGVHD severity and significantly lower for severe cGVHD compared to moderate cGVHD (P=0.01, Figure 1A). Severe cGVHD had a remarkable adverse impact on physical aspects of QOL (the physical component score (PCS) of the SF-36 and PWB, both P<0.001, Figure 1B). Oral, gastrointestinal, musculoskeletal and pulmonary involvement was strongly associated with poor QOL. Multivariable logistic regression analysis revealed the positive impact of employment status on physical and functional aspects of QOL (PCS: HR 0.41, P=0.018 and the functional well-being score (FWB) of the FACT-BMT: HR 0.27, P<0.001), in addition to the significant correlation between cGVHD severity and the perception of QOL. The FWB was significantly higher in patients with severe cGVHD who had a work compared to those who did not (P=0.02).
Discussion: The impairment of QOL was particularly prominent among the patients with severe cGVHD. Preventing severe cGVHD and promoting reintegration into society might improve overall QOL outcome in long-term survivors after HSCT.
