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评价自体造血干细胞移植对老年淋巴瘤患者生活质量的影响。

Evaluation of the Impact of Autologous Hematopoietic Stem Cell Transplantation on the Quality of Life of Older Patients with Lymphoma.

机构信息

Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.

Division of Hematology and Medical Oncology, Hematopoietic Cell Transplant Program, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.

出版信息

Biol Blood Marrow Transplant. 2020 Jan;26(1):157-161. doi: 10.1016/j.bbmt.2019.09.007. Epub 2019 Sep 12.


DOI:10.1016/j.bbmt.2019.09.007
PMID:31521818
Abstract

High-dose chemotherapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) improves survival in patients with chemosensitive non-Hodgkin lymphoma (NHL). Determination of the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) has contributed to improve patient selection while allowing for prediction of nonrelapse mortality. We previously demonstrated the efficacy and safety of AHSCT in a cohort of older patients with chemosensitive NHL. Quality of life following AHSCT still has not been widely evaluated. The goal of this study was to assess the long-term quality of life of elderly patients surviving AHSCT. This single-center, Research and Ethics Committee-approved study investigated QoL in survivors of AHSCT for the treatment of NHL in a cohort of older patients. Inclusion criteria were defined as patients age ≥60 years who underwent AHSCT for NHL between January 1, 2008, and January 1, 2015, at our center. Fifty-nine patients from the original cohort of 90 survived at a median of 50 months post-AHSCT. Forty-seven (79.7%) of those patients agreed to complete the QoL assessment questionnaires after the transplantation and are included in this report. All patients provided signed 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, social/family, emotional, and functional well-being 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, which requires significant negative effects in 4 or 5 domains. Lower Karnofsky Performance Status (KPS) score at the time of transplantation was negatively correlated with mobility (P= .001), self-care (P= .001), and usual activities (P= .007) dysfunction. Anxiety was significant for patients in relapsed after transplantation (P= .002). FACT-BMT questionnaire results demonstrated that physical, social, and emotional well-being were all well preserved after the transplantation, whereas functional well-being was more variable among patients. Relapse was associated with impaired functional well-being (P= .007) and lower total FACT-BMT score (P= .014). Other comparators, including the conditioning regimen, sex, age subgroups (<65 or ≥65 years), HCT-CI score, and disease status at transplantation, did not impact any of these outcomes. This study demonstrates that physical, social, and functional well-being are preserved in older patients following AHSCT. Low KPS score before AHSCT is a predictor of disability at distance from AHSCT. Relapse following AHSCT remains the most significant impediment to maintaining a good QoL. Innovative interventions to improve performance status before transplantation and measures to prevent relapse thereafter should be investigated to improve survival and QoL.

摘要

大剂量化疗(HDT)联合自体造血干细胞移植(AHSCT)可提高化疗敏感型非霍奇金淋巴瘤(NHL)患者的生存率。造血细胞移植合并症指数(HCT-CI)的确定有助于改善患者选择,同时可以预测非复发死亡率。我们之前已经证明了 AHSCT 在老年化疗敏感型 NHL 患者中的疗效和安全性。AHSCT 后的生活质量尚未得到广泛评估。本研究的目的是评估老年接受 AHSCT 治疗的 NHL 患者的长期生活质量。这项单中心研究,经研究和伦理委员会批准,对年龄≥60 岁、于 2008 年 1 月 1 日至 2015 年 1 月 1 日期间在我们中心接受 NHL 治疗的 AHSCT 幸存者的 QoL 进行了评估。在最初的 90 例患者中,有 59 例患者在 AHSCT 后中位 50 个月存活下来。在这些患者中,有 47 例(79.7%)在移植后同意完成 QoL 评估问卷,并纳入本报告。所有患者均签署了知情同意书。我们使用 EQ-5D 量表评估移动性、自理能力、日常活动、疼痛/不适和焦虑/抑郁,使用功能性评估癌症治疗-骨髓移植(FACT-BMT)问卷评估身体、社会/家庭、情感和功能方面的健康状况和骨髓移植相关问题。使用这两种工具时,分数越高表示 QoL 越好。在进行 QoL 评估时,15%的患者疾病复发。在 EQ-5D 中,只有少数患者(9%)报告存在严重障碍,需要在 4 或 5 个领域有明显的负面影响。移植时 Karnofsky 表现状态(KPS)评分较低与移动性(P=.001)、自理能力(P=.001)和日常活动(P=.007)障碍呈负相关。移植后复发的患者焦虑显著(P=.002)。FACT-BMT 问卷结果表明,移植后患者的身体、社会和情感健康状况均得到良好保存,而功能健康状况在患者之间变化较大。疾病复发与功能健康状况受损(P=.007)和总 FACT-BMT 评分降低(P=.014)相关。其他比较因素,包括预处理方案、性别、年龄亚组(<65 岁或≥65 岁)、HCT-CI 评分和移植时疾病状态,均未对这些结果产生影响。本研究表明,AHSCT 后老年患者的身体、社会和功能健康状况得到保留。AHSCT 前 KPS 评分较低是 AHSCT 后残疾的预测因素。AHSCT 后疾病复发仍然是维持良好 QoL 的最大障碍。为了提高生存率和 QoL,应研究改善移植前表现状态的创新干预措施和预防疾病复发的措施。

相似文献

[1]
Evaluation of the Impact of Autologous Hematopoietic Stem Cell Transplantation on the Quality of Life of Older Patients with Lymphoma.

Biol Blood Marrow Transplant. 2020-1

[2]
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[3]
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[4]
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[5]
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[6]
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Biol Blood Marrow Transplant. 2014-12

[7]
[Preliminary assessment of immune reconstitution after autologous peripheral hematopoietic stem cell transplantation (AHSCT)].

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[8]
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Biol Blood Marrow Transplant. 2020-8

[9]
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[10]
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Transplant Cell Ther. 2023-8

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[3]
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[4]
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[5]
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[7]
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[8]
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