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Quality of Life
Patient-reported outcomes and health status associated with chronic graft-versus-host disease
Ferrata Storti Foundation
Stephanie J. Lee,1 Lynn Onstad,1 Eric J. Chow,1 Bronwen E. Shaw,2 Heather S.L. Jim,3 Karen L. Syrjala,1 K. Scott Baker,1 Sarah Buckley1 and Mary E. Flowers1
1Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; 2Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI and 3Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
Haematologica 2018 Volume 103(9):1535-1541
ABSTRACT
Chronic graft-versus-host disease occurs in 20-50% of allogeneic hematopoietic cell transplant survivors. We surveyed patients about their quality of life, symptoms, health status, comorbid conditions and medications. Instruments included the Short-Form-36 (SF- 36), the Patient-Reported Outcomes Measurement Information System (PROMIS) Global and PROMIS-29 scales and the Lee Chronic Graft-ver- sus-Host Disease Symptom Scale. Functional status was measured by self-reported Karnofsky performance status and work status. Of 3027 surveys sent to recipients surviving one or more years after transplanta- tion, 1377 (45%) were returned. Among these, patients reported that their chronic graft-versus-host disease was mild (n=257, 18.7%), moder- ate (n=110, 8.0%) or severe (n=25, 1.8%). Another 377 (27.4%) had never had chronic graft-versus-host disease and 280 (20.3%) had had chronic graft-versus-host disease but it had resolved. We excluded 328 (23.8%) patients who did not answer the questions about chronic graft-versus- host disease. Patients who reported moderate or severe chronic graft-ver- sus-host disease reported worse quality of life, lower performance status, a higher symptom burden and were more likely to be taking prescription medications for pain, anxiety and depression compared to those with resolved chronic graft-versus-host disease. Self-reported measures were similar between patients with resolved chronic graft-versus-host disease and those who had never had it. Our data suggest that the PROMIS measures may be able to replace the SF-36 in the assessment of chronic graft-versus-host disease. Between 26.7-39.4% of people with active chronic graft-versus-host disease were unable to work due to health rea- sons, compared with 12.1% whose chronic graft-versus-host disease had resolved and 15.4% who had never had chronic graft-versus-host disease. Mouth, eye and nutritional symptoms persisted after resolution of chron- ic graft-versus-host disease. These results show that better prevention of and treatment for chronic graft-versus-host disease are needed to improve survivorship after allogeneic transplantation.
Introduction
Approximately 20-50% of transplant survivors experience chronic graft-versus-host disease (GvHD), the most common late complication of allogeneic hematopoietic cell transplantation (HCT). Chronic GvHD is an iatrogenic complication of HCT that occurs when the donor’s immune system attacks the recipient’s tissues. The onset is typically 4-6 months after transplantation and three or more organs are involved in the majority of cases.1 Risk factors include older age of the recipient, use of peripheral
Correspondence:
sjlee@fredhutch.org.
Received: March 7, 2018. Accepted: May 25, 2018. Pre-published: June 1, 2018.
doi:10.3324/haematol.2018.192930
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/9/1535
©2018 Ferrata Storti Foundation
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haematologica | 2018; 103(9)
1535
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