Fatigue: A Long Standing Symptom Affecting Quality of Life in Patients Following Hematopoietic Cell Transplantation

Objective: Hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for malignant and autoimmune diseases.  As the scope of transplant expands treatment for more diseases and patient types, quality of life (QOL) specifically fatigue, will remain an important measure for outcome and long term survival in HSCT.   Overall QOL is reported to return to baseline or exceeds baseline by one year while fatigue remains a major symptom that is long lasting as far out as 10 years.

Methods: A Pub Med search was completed in 2009 using mesh terms, HSCT, bone marrow transplant, and quality of life. This resulted in one hundred and seventy nine articles.  When fatigue was added to the mesh terms the number of articles dropped to eleven.  Highly relevant references were chosen from articles and books.  The National Comprehensive Cancer Network (NCCN) website was also used as a source for cancer related fatigue.

Results: Long term follow up studies of HSCT patients as far out as ten years report fatigue as high as 35%. In comparative trials with healthy controls this has been shown to be statistically significant.  Multiple reasons may exist for this prolonged decrement including chronic graft versus host disease, preparative regimens, treatment prior to HSCT and underlying disease.  No studies to date have determined the underlying etiology of long standing fatigue. Small studies with exercise interventions and cognitive behavioral therapy show promising results. These types of treatment may have an impact on patients with fatigue following HSCT. 

Conclusion:  Multidimensional scales have been used to measure fatigue in many QOL studies but few to date have used fatigue specific scales. Multimodal interventions have been shown to decrease the loss of aerobic fitness, muscle strength, and functional performance.  Interventions with exercise in addition to behavioral therapy with objective physical measures and fatigue measurement scales may be beneficial in determining the cause of this chronic symptom in patients post HSCT.