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Factors Associated with Fatigue in Chronic Graft-Versus-Host Disease

Track: Poster Abstracts
Wednesday, February 26, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Annie Im, MD , Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
Sandra Mitchell, PhD, CRNP , Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
Seth Steinberg, PhD , Biostatistics and Data Management Section, National Cancer Institute, NIH, Bethesda, MD
Lauren Curtis, MD , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Ann Berger, MD , Pain and Palliative Care, National Cancer Institute, NIH, Besthesda, MD
Kristin Baird, MD , Pediatric Oncology Branch, National Cancer Institute, NIH, Bethesda, MD
Zoya Kuzmina, MD , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Dan Zhang , Biostatistics and Data Management Section, National Cancer Institute, NIH, Bethesda, MD
Kristen Cole, RN, BSN, OCN , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Daniele Avila, CRNP , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Tiffani Taylor, PA-C , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Judy L Baruffaldi , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Steven Z. Pavletic, MD , Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, MD
Background

Chronic graft-versus-host disease (cGVHD) is a major cause of morbidity and non-relapse mortality after allogeneic hematopoietic cell transplantation (HCT).  Although fatigue is common after HCT, little is known about fatigue in patients with cGVHD.  The aim of this study was to explore factors associated with fatigue in cGVHD.

Methods

Data were drawn from a cohort of adults with cGVHD (n=263).  To classify patients as fatigued, a single item (extent to which respondent was bothered in the past month by loss of energy [LOE]) from the Lee cGVHD Symptom Scale was employed.  Those who were ‘not at all’, ‘slightly’, or ‘moderately’ bothered by LOE were classified as not fatigued; those who were ‘quite a bit’ or ‘extremely’ bothered were classified as fatigued. Nonparametric tests were used to compare variables of interest in patients with and without fatigue; logistic regression was used to model predictors of fatigue.  

Results

In univariate analysis, several parameters were significantly associated (p<0.005) or demonstrated a trend towards significant association (0.005≤p<0.05) with fatigue (Table 1).  Factors not associated were NIH global severity score, NIH organ scores, # of involved organs, time since cGVHD onset,  platelets, hemoglobin, albumin, erythematous or sclerotic skin involvement, intensity of immunosuppression, therapeutic intent at time of evaluation, age, gender, BMI, conditioning regimen, donor source, C3, C4, prealbumin, ferritin, lung function score, FEV1, respiratory symptoms, range of motion, and grip strength.  Logistic regression modeling initially including factors associated with fatigue in univariate analysis demonstrated that having received peripheral blood stem cells (PBSC) and having impairments in self-rated physical and mental health predicted fatigue.  Fatigued respondents had SF36 physical component score (PCS) and mental component score (MCS) means that were markedly lower than US normative value, and human activity profile (HAP) scores reflecting limitation in daily activities.

Conclusions

The absence of association with either NIH cGVHD global severity or organ scores suggests that fatigue in cGVHD patients may have a distinct pathogenesis.  The association with ESR and CRP point towards possible inflammatory mediators.  Findings confirm the deleterious impact of fatigue on self-rated health and daily activities, and emphasize the need for routine screening in HCT survivors.  Further study of the characteristics, correlates, and consequences of fatigue in cGVHD is warranted.

Table 1. Univariate analysis

 

 

Not fatigued

(N=160)

Fatigued 

(N=103)

p

# prior cGVHD therapies

3.5

4.2

0.007

PCS

39.3

29.9

<0.0001

MCS

50.4

42.4

<0.0001

ESR

22.6

28.8

0.007

CRP

6.1

7.7

0.019

TSH

1.8

2.2

0.035

HAP max activity score

74.7

65.4

<0.0001

HAP adj activity score

64.8

50.0

<0.0001

Nutrition score PG-SGA

6.0

9.6

<0.0001

 

 

p

KPS

<0.0001

Walk velocity

<0.0001

PBSC

0.0077

 

 

Disclosures:
Nothing To Disclose
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