Gvhd Impact On Quality of Life, Health, Sexuality and Fatigue of LONG TERM Survivors After Hematopoietic STEM CELL Transplant

HSCT is a clinical procedure that involves lethal risk. However, it sometimes arises as the only possibility for survival. Patients find a multiplicity of side effects resulting from the illness and its treatment. Graft versus host disease (GVHD) is one of the most important causes of morbidity after HSCT. We designed this study in order to evaluate the impact of graft versus host disease on QoL healtth, sexuality and fatigue in long term survivors after HSCT. This is a prospective seccional study of 214 long term survivors after HSCT, which were divided in two groups for comparison: Group 1 (G1=89) survivors with GVHD e Group 2 (G2=125) without GVHD.  G1 was further divided into three groups according to GVHD classification: Group a (Ga) – acute GVHD; Group c (Gc) – chronic GVHD; Grupo ac (Gac) acute and chronic GVHD. Level of satisfaction about QoL, sexuality, health and fatigue were evaluated. All patients had at least 18 years old. Scales used were: WHOQOL, Functional Assessment of Cancer Therapy: Fatigue FACT-F, Karnofsky Performance Status Scale and Socioeconomic demographic survey. Level of significance in all scales was 95% (p ≤ 0.05)  for all risk factors for QoL.

Among survivors from groups G1 and G2, there were more males (61.8% and 67%), married (63% 54.8%), and low socio economic status (67.4% and 61.3) patients. Both groups had similar percentage of survivors with more than eight years of scholarship (67%). Median age of survivor from G1 was 39±10 years and from G2, 32±9.6 years.

Most of G1 survivors (67.4%) were 25.9 ±10.8 years old at the time of transplant versus 19.5±10 years old for G2. Malignant diseases were predominant at G1 (60.7%) when compared to G2 (29.8%). At the time of the study, 73% of survivors from G1 and 82% from G2 had 10 to 15 years after HSCT. Pre and post HSCT Karnofsky scores were similar for both groups: G1 (89.9% e 98.9%), G2 (83.9% e 99.2%). Survivors from both groups reported satisfaction with QoL, health, and sexuality. 65.2% from G1 and 75.4% from G2 reported absence of fatigue. These results show that level of satisfaction of long term survivors with their QoL, health, sexuality and fatigue were favorable in spite of having been diagnosed with acute or chronic graft-versus-host-disease. Transplantation provides an opportunity for changes in subjectivity and in facing life's adversities. It is therefore crucial that the QOL assessment can be part of the clinical protocol, once it provides information about risk factor which allow for the best choice of interventions.