Public Health Sciences, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA 98109, USA.
Brain Behav Immun. 2013 Mar;30 Suppl(Suppl):S142-8. doi: 10.1016/j.bbi.2012.07.020. Epub 2012 Aug 13.
Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.
清髓性造血细胞移植（HCT）是治疗血液系统恶性肿瘤的常用方法。HCT 后免疫重建延迟是恢复的主要障碍，患者在移植后第一个月最易受到影响。HCT 是一个高度应激的过程。由于心理困扰与免疫功能下调有关，我们研究了 70 例成年自体 HCT 患者在移植后前 3 周内移植前的困扰对白细胞（WBC）计数的影响。参与者的平均年龄为 38 岁；93%为白种人，非西班牙裔，55%为男性。移植前的困扰通过癌症和治疗困扰量表（CTXD）和症状清单-90-R（SCL-90-R）焦虑和抑郁分量表在入院前 2-14 天进行测量。WBC 计数在移植后第 5 天至第 22 天初始免疫恢复期间进行测量。线性混合模型回归分析控制性别和治疗相关变量后，发现术前 SCL 焦虑-抑郁评分的平均值对 WBC 恢复有显著影响。我们发现术前 CTXD 对 WBC 恢复没有显著影响。一般来说，较高水平的术前焦虑和抑郁与 WBC 恢复较慢有关。HCT 期间 WBC 恢复的心理调节表明，心理困扰可以通过一种独特的机制对免疫系统产生影响。鉴于 WBC 恢复对 HCT 患者的生存至关重要，这些数据为治疗 HCT 患者的焦虑和抑郁提供了依据。
