Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
Department of Medicine, Division of Hematology/Oncology, University of Wisconsin-Madison, Madison, WI, USA.
J Natl Cancer Inst. 2021 Oct 1;113(10):1405-1414. doi: 10.1093/jnci/djab032.
Allogeneic hematopoietic cell transplantation (HCT) is a widely used treatment for hematologic cancers, with survival rates ranging from 25% to 78%. Known risk factors for chronic graft-versus-host disease (cGVHD), a serious and common long-term complication, disease relapse, and mortality following HCT have been identified, but much of the variability in HCT outcomes is unexplained. Biobehavioral symptoms including depression, sleep disruption, and fatigue are some of the most prevalent and distressing for patients; yet research on biobehavioral risk factors for HCT outcomes is limited. This study evaluated patient-reported depression, sleep disruption, and fatigue as risk factors for cGVHD, disease relapse, and mortality.
Adults receiving allogeneic HCT for a hematologic malignancy (N = 241) completed self-report measures of depression symptoms, sleep quality, and fatigue (severity, interference) pre-HCT and 100 days post-HCT. Clinical outcomes were monitored for up to 6 years.
Cox proportional hazard models (2-tailed) adjusting for patient demographic and medical characteristics revealed that high pre-HCT sleep disruption (Pittsburgh Sleep Quality Index >9; hazard ratio [HR] = 2.74, 95% confidence interval [CI] = 1.27 to 5.92) and greater post-HCT fatigue interference (HR = 1.32, 95% CI = 1.05 to 1.66) uniquely predicted increased risk of mortality. Moderate pre-HCT sleep disruption (Pittsburgh Sleep Quality Index 6-9) predicted increased risk of relapse (HR = 1.99, 95% CI = 1.02 to 3.87). Biobehavioral symptoms did not predict cGVHD incidence.
Biobehavioral symptoms, particularly sleep disruption and fatigue interference, predicted an increased risk for 6-year relapse and mortality after HCT. Because these symptoms are amenable to treatment, they offer specific targets for intervention to improve HCT outcomes.
异基因造血细胞移植（HCT）是治疗血液系统恶性肿瘤的一种广泛应用的方法，其生存率在 25%至 78%之间。已经确定了慢性移植物抗宿主病（cGVHD）、疾病复发和 HCT 后死亡率的已知风险因素，cGVHD 是一种严重且常见的长期并发症，但 HCT 结果的很大一部分仍无法解释。抑郁、睡眠障碍和疲劳等生物行为症状是患者最常见和最痛苦的症状之一；然而，关于 HCT 结果的生物行为风险因素的研究有限。本研究评估了患者报告的抑郁、睡眠障碍和疲劳作为 cGVHD、疾病复发和死亡率的风险因素。
接受异基因 HCT 治疗血液恶性肿瘤的成年人（N=241）在 HCT 前和 HCT 后 100 天完成了抑郁症状、睡眠质量和疲劳（严重程度、干扰）的自我报告测量。对临床结果进行了长达 6 年的监测。
调整患者人口统计学和医学特征的 Cox 比例风险模型（双侧）显示，高 HCT 前睡眠障碍（匹兹堡睡眠质量指数>9；风险比[HR] = 2.74，95%置信区间[CI] = 1.27 至 5.92）和更大的 HCT 后疲劳干扰（HR = 1.32，95%CI = 1.05 至 1.66）可预测死亡率增加的风险。HCT 前中度睡眠障碍（匹兹堡睡眠质量指数 6-9）预测复发风险增加（HR = 1.99，95%CI = 1.02 至 3.87）。生物行为症状不能预测 cGVHD 的发生率。
生物行为症状，特别是睡眠障碍和疲劳干扰，预测了 HCT 后 6 年复发和死亡率增加的风险。由于这些症状可以治疗，因此为改善 HCT 结果提供了具体的干预目标。
