Evaluation of the Impact of Autologous Hematopoietic Stem Cell Transplantation on the Quality of Life of Older Lymphoma Patients.
Hôpital Maisonneuve-Rosemont, Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) improves survival in patients with chemosensitive non-Hodgkin lymphoma (NHL) [1-3]. Determination of the hematopoietic cell transplant comorbidity index (HCT-CI) has contributed to improve patient selection while allowing prediction of their non-relapse mortality (NRM) [4,5]. We previously demonstrated the efficacy and safety of AHSCT in a cohort of older patients with chemosensitive NHL . QoL following AHSCT is still not widely evaluated. The goal of this study was to assess the long-term quality of life (QoL) of those elderly patients surviving AHSCT. This single center, research and ethic committee approved study, investigated QoL in survivors following AHSCT for the treatment of NHL in a cohort of older patients. Inclusion criteria were defined as patient aged ≥ 60 who received an AHSCT for NHL between January 1st, 2008 and January 1st, 2015 at our center. Fifty-nine patients from the original cohort of 90 survived at a median time of 50 months post AHSCT. Forty-seven (79.7%) of those patients agreed to complete the QoL assessment questionnaires after the transplant and are included in this report. Patients were all required to sign an informed consent. We used the EQ-5D instrument to assess mobility, self-care, usual activities, pain/discomfort and anxiety/depression and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) questionnaire to assess physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB) and (BMT) specific concerns. With both tools, a higher score indicates better QoL. Fifteen percent of patients were in relapse at the time of the QoL assessment. In the EQ-5D, few patients (9%) reported severe impairment, requiring four or five domains being negatively affected. Lower Karnofsky index at the time of transplant negatively correlated with mobility (p=0,001), self-care (p=0,001) and usual activities (p=0,007) dysfunction. Anxiety was significant for patients in relapsed after transplant (p=0,002). FACT-BMT questionnaire results demonstrated that physical, social and emotional well-being are all well preserved after the transplant while functional well-being is more variable among patients. Relapse was associated with impaired functional well-being (p=0,007) and lower total FACT-BMT score (p=0,014). Other comparators, including the conditioning regimen, gender, age subgroups (<65 or ≥65 years old), HCT-CI score and disease status at transplant did not impact on any of these outcomes. This study demonstrates that physical, social and functional well-being are preserved in older patients following AHSCT. Low Karnosfky score prior transplant is a predictor of disability at distance from AHSCT. Relapse following AHSCT remains the most significant impediment to maintain a good QoL. Innovative interventions to improve performance status prior transplantation and measures to prevent relapse thereafter should be investigated to improve survival and QoL.
Biol. Blood Marrow Transplant. 2019.
Pubmed ID: 31521818