Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns

Abstract

This prospective longitudinal study examined the quality of life (QOL) after hematopoietic cell transplantation (HCT) and identified risk factors of poor QOL in 312 adult autologous and allogeneic HCT patients. Physical, psychological, social, and spiritual well-being was assessed before HCT, 6 months, and 1, 2, and 3 years after HCT. For all HCT patients, physical QOL was stable from before to after HCT (P > .05); psychologic (P < .001), social (P < .001), and spiritual (P = .03) QOL improved at 6 months. Study noncompleters (because of illness or death) had worse QOL. Allogeneic patients reported worse physical and psychologic well-being (P < .05). Older patients reported worse physical but better social well-being regardless of HCT type (P < .05). Two or more domains were affected by race/ethnicity, household income, and education in autologous patients, and by body mass index (BMI), decline in BMI, primary diagnosis, and chronic graft-versus-host disease (GVHD) in allogeneic patients (P < .05). At 3 years, 74% of HCT patients were employed full or part time. Older autologous patients with lower pre-HCT income were less likely to work (P < .05); allogeneic patients with chronic GVHD were less likely to work (P = .002). Multidisciplinary efforts to identify and support vulnerable subgroups after HCT need to be developed.

Figure 1

Flow chart of study enrollment and participation.

Figure 2

GEE estimates of the longitudinal trends of QOL domains for autologous and allogeneic HCT patients combined (solid lines), and for autologous (dotted lines) and allogeneic (dashed lines) patients separately. ○ indicates observed means for autologous HCT patients; and ●, observed means for allogeneic HCT patients.

Figure 3

Pattern mixture model estimates of GEE longitudinal trends. Graphs show GEE longitudinal trends of QOL domains (broken lines) and observed means (symbols) by survival/completer status and GEE longitudinal trends for all patients combined (solid lines).

Figure 4

Proportion of HCT patients returning to work. Graphs show proportions of HCT patients returning to full- or part-time work by time since HCT according to (A) part-time or full-time status; (B) stem cell source; and (C) chronic GVHD status in allogeneic HCT recipients.