Association Between Baseline Patient-Reported Outcomes and Complications of Hematopoietic Stem Cell Transplantation

Depression in patients with hematologic malignancies: The current landscape and future directions

Patients with hematologic malignancies experience high rates of depression. These patients are vulnerable to depression throughout the disease trajectory, from diagnosis to survivorship, and at the end of life. In addition to the distressing nature of depression, it has substantial downstream effects including poor quality of life, increased risk of treatment complications, and worse survival. Therefore, systematic screening for depression and integration of robust psychological interventions for affected patients is crucial. Although depression has been historically studied mostly in patients with solid malignancies, research focusing on patients with hematologic malignancies is growing. In this article, we describe what is known about depression in patients with hematologic malignancies, including its assessment, prevalence, risk factors, and implications. We also describe interventions to ameliorate depression in this population. Future research is needed to test effective and scalable interventions to reduce the burden of depression among patients with blood cancers.

Assessment of rehabilitation practices during hematopoietic stem cell transplantation in the United States: a survey

Background

Rehabilitation therapy is important to treat physical and functional impairments that may occur in individuals receiving physically taxing, yet potentially curative hematopoietic stem cell transplants (HSCT). However, there is scarce data on how rehabilitation is delivered during HSCT in real-life setting. Our objective is to assess the rehabilitation practices for adult patients hospitalized for HSCT in the United States.

Methods

A 48-question online survey with cancer centers with the top 10% HSCT volumes (per American registries). We obtained data on patient characteristics, rehabilitation therapy details (timing, indication, administering providers), physical function objective and subjective outcome measures, and therapy activity precautions.

Results

Fourteen (out of 21) institutions were included. Rehabilitation therapy referrals occurred at admission for all patients at 35.7% of the centers for: functional decline (92.9%), fall risk (71.4%), and discharge planning (71.4%). Participating institutions had physical therapists (92.9%), occupational therapists (85.7%), speech language pathologists (64.3%) and therapy aides (35.7%) in their rehabilitation team. Approximately 71% of centers used objective functional measures including sit-to-stand tests (50.0%), balance measures (42.9%), and six-minute walk/gait speed (both 35.7%). Monitoring of blood counts to determine therapy modalities frequently occurred and therapies held for low platelet or hemoglobin values; but absolute neutrophil values were not a barrier to participate in resistance or aerobic therapies (42.9%).

Discussion

Rehabilitation practices during HSCT varied among the largest volume cancer centers in the United States, but most centers provided skilled therapy, utilized objective, clinician and patient reported outcomes, and monitored blood counts for safety of therapy administration.

Health-Related Quality of Life in Double Umbilical Cord Blood versus Haploidentical Marrow Transplantation: A Quality of Life Analysis Report of BMT CTN 1101

The Blood and Marrow Transplant Clinical Trials Network study 1101 (BMT CTN 1101; ClinicaTrials.gov identifier NCT01597778) was a multicenter phase III randomized trial comparing the clinical outcomes and quality of life (QoL) of patients with hematologic malignancies undergoing double umbilical cord blood transplantation (dUCBT) or HLA-haploidentical bone marrow transplantation (haplo-BMT) after reduced-intensity conditioning. At a 5-year follow-up, there were no significant differences in progression- free survival (PFS) or overall survival (OS) between the 2 cohorts. The impact of alternative donor source on QoL is unknown, however. English- and Spanish-speaking patients completed the Functional Assessment of Cancer Therapy-General (FACT-G), Short Form 36 (SF-36), EuroQoL-5 Dimensions EQ-5D, and Global QoL patient-reported outcome (PRO) assessments pretransplantation and at 12 and 24 months post-transplantation. We compared longitudinal QoL measures between the dUCBT and haplo-BMT cohorts and investigated the association of QoL and clinical outcomes using an inverse probability weighted-independent estimating equations method, accounting for missingness and baseline variables. We found no significant differences between the 2 cohorts in any of the QoL scores pretransplantation and at 12 and 24 months post-transplantation. Pretransplantation scores were the only significant predictors of post-transplantation QoL scores. Relapse and grade III-IV acute graft-versus-host disease (GVHD) were associated with significant declines in mean FACT-BMT and SF-36 Physical Component scores, and chronic GVHD was associated with a decline in mean EQ-5D utility scores. There were no significant associations between pretransplantation QoL scores and OS or PFS. Donor type did not impact post-transplantation QoL. Pretransplantation QoL scores and clinical events of GVHD and relapse were the only predictors of post-transplantation QoL. QoL was not associated with survival in either treatment arm. PROs may be valuable tools in pretransplantation risk assessment strategies to improve QoL outcomes.

Association Between Depression Before Hematopoietic Stem Cell Transplantation and Posttransplant Survival: A Systematic Review and Meta-analysis

BACKGROUND

Depressive symptoms are often found in patients undergoing hematopoietic stem cell transplantation (HSCT). However, the impact of depression on overall survival and other outcomes after HSCT has not been systematically reviewed.

OBJECTIVE

The objective of this review was to determine if depression before HSCT is associated with poor posttransplant outcomes.

METHODS

We performed a systematic research, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM) guidelines based on several databases (MEDLINE, EMBase, and PsycINFO) for cohort studies on adults undergoing HSCT, comparing overall survival or other outcomes (length of aplasia, infectious complications) between patients with depressive symptoms and controls. For studies reporting overall survival hazard ratios, we conducted a meta-analysis by calculating a 95% confidence interval hazard ratios, and we assessed heterogeneity with the I² statistic. Study quality was assessed using the Newcastle-Ottawa Quality Assessment scale for cohort studies.

RESULTS

A total of 18 studies were included in the systematic review (22,235 participants) and 8 in the meta-analysis. There were a variety of depression screening tools, the Hospital Anxiety and Depression Scale (HADS) being the most reported questionnaire. A significant association between depression and overall survival was found in 9 studies, whereas 8 studies shown no association. Depression tended to have an impact on length of aplasia and infectious complications. In the meta-analysis, depression was found to impact significantly overall survival after HSCT with a hazard ratio = 1.07 (95% confidence interval 1.03-1.11). A publication bias was found in the meta-analysis.

CONCLUSION

Depression seems to have a significant impact on post-HSCT survival and on length of aplasia. A systematic screening of depression before HSCT should be considered, with validated tools such as HADS. Future research needs to be done to measure the impact of depression on HSCT response and understand its physiopathology.

Fatigue among post-hematopoietic stem cell transplant patients in Jordan: prevalence and associated factors

BACKGROUND

During hematopoietic stem cell transplant (HSCT), patients underwent various serious prolonged treatments, including conditioning and immunosuppressive drugs, resulting in several symptoms and alterations in the patient's functioning. One of the most commonly reported symptoms is fatigue.

AIM

To assess fatigue levels and associated factors during the first 100 days post-HSCT among Jordanian patients.

METHODS

A descriptive cross-sectional design assessed fatigue and associated factors during the first 100 days post-HSCT among Jordanian patients. A convenient sample was used to recruit post-HSCT patients. Data were collected using the demographic survey and the Brief Fatigue Inventory (BFI) scale.

RESULTS

The findings of this study demonstrated that 40.5% of the participants had severe total fatigue scores, while the mean BFI intensity average score was 5.01 and the mean interference of fatigue with patients' daily life was 5.06. In terms of fatigue interference with daily activities, the highest interference was with the patient's mood and normal work, while the lowest interference was with the walking ability. The analysis revealed a strong positive correlation between the fatigue intensity and its interference with the daily activities (r = .98, p ˂.001). Besides, a significantly strong negative correlation was found between the number of days post-HSCT and fatigue scores (r =  - .92, p ˂.001).

CONCLUSION

Post-transplant, patients experienced increased fatigue intensity, reduced physical activity, interference with the patient's mood, and diminished functional capacity. Patients who have HSCT require a significant nursing care immediately post-transplant.

Digital Life Coaching during Stem Cell Transplantation: A Pilot Feasibility Study

BACKGROUND

For patients with multiple myeloma receiving high-dose chemotherapy followed by autologous stem cell transplantation (SCT), acute life disruptions and symptom burden may lead to worsened quality of life (QOL) and increased emotional distress. Digital life coaching (DLC), whereby trained coaches deliver personalized wellbeing-related support via phone calls and text messages, has been shown to improve QOL among SCT survivors. However, DLC has not been investigated during the acute peri-SCT period which is generally characterized by symptomatic exacerbations and 2-week hospitalizations.

OBJECTIVE

We launched a single-arm pilot study to investigate the feasibility of patient engagement with DLC during this intensive period.

METHODS

We approached English-speaking adult patients with multiple myeloma undergoing autologous SCT at our center. Enrolled patients received 16 weeks of virtual access to a life coach beginning at Day -5 before SCT. Coaches used structured frameworks to help patients identify and overcome personal barriers to wellbeing. Patients chose the coaching topics and preferred communication styles. Our primary endpoint was ongoing DLC engagement, defined as bidirectional conversations occurring at least once every four weeks during the study period. Secondary endpoints were electronic patient-reported outcome (ePRO) assessments of QOL, distress, and sleep disturbances. Our study was registered as clinicaltrials.gov identifier NCT04432818.

RESULTS

Of 20 screened patients, 17 patients chose to enroll and 15 underwent SCT as planned. Of these 15 patients (median age 65, range 50-81), 73% (n = 11) demonstrated ongoing DLC engagement. The median frequency of bidirectional conversations during the 3-month study period was once per 6.2 days (range: 3.9-28). During index hospitalizations with median lengths of stay 16 days (range 14-31), the median frequency of conversations was once per 5.3 days (range 2.7-15). ePRO assessments (94% adherence) demonstrated an expected QOL nadir during the second week following SCT. The prevalence of elevated distress was highest immediately before and after SCT, with 69% of patients exhibiting elevated distress at Day -5 and at Day +2.

CONCLUSIONS

DLC may be feasible for older patients during intensive hospital-based cancer treatments such as autologous stem cell transplantation for multiple myeloma. Limitations of our study include small sample size, selection bias among enrolled patients, and heterogeneity in DLC usage. Based on the positive results of this pilot study, a larger phase 2 randomized study of DLC during SCT is under way to investigate its efficacy with regard to patient wellbeing.

CLINICALTRIAL

Our study was registered as clinicaltrials.gov identifier NCT04432818.