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