Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
Transplant Cell Ther. 2021 Aug;27(8):679.e1-679.e8. doi: 10.1016/j.jtct.2021.04.013. Epub 2021 Apr 22.
Young adult (YA) survivors of allogeneic hematopoietic cell transplantation (HCT) are at risk for late psychosocial challenges, including the inability to return to work post-HCT. Work-related outcomes in this population remain understudied, however. We conducted this study to assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YAs and to analyze the patient-, disease-, and HCT-related factors associated with their work status at 1 year post-HCT. Using Center for International Blood and Marrow Transplant Research data, we evaluated the post-HCT work status (full-time, part-time work, unemployed, or medical disability) of 1365 YA HCT survivors who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at 4 time points: 6 months, 1 year, 2 years, and 3 years post-HCT. Percentages of post-HCT work status categories at the 1-year time point were also described in relation to survivors' pre-HCT work status categories. Factors associated with 1-year post-HCT work status (full-time or part-time work) were examined using logistic regression. From 6 months to 3 years post-HCT, the percentage of survivors working full-time increased from 18.3% to 50.7% and the percentage working part-time increased from 6.9% to 10.5%. Of patients in full-time work pre-HCT, 50% were unemployed or on medical disability at 1 year post-HCT. Female sex (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.40 to 0.77), HCT Comorbidity Index score ≥3 (OR, 0.57; 95% CI, 0.39 to 0.82), pre-HCT unemployment (OR, 0.37; 95% CI, 0.24 to 0.56), medical disability (OR, 0.44; 95% CI, 0.28 to 0.70), development of grade III-IV acute graft-versus-host disease (OR, 0.52; 95% CI, 0.34 to 0.80), and relapse within 1 year post-HCT (OR, 0.34; 95% CI, 0.21 to 0.56) were associated with a lower likelihood of employment at 1 year post-HCT. Compared with myeloablative conditioning (MAC) with total body irradiation (TBI), MAC without TBI (OR, 1.71; 95% CI, 1.16 to 2.53) was associated with a greater likelihood of employment at 1 year post-HCT. Graduate school-level education (OR, 2.47; 95% CI, 1.49 to 4.10) was also associated with a greater likelihood of employment at 1 year post-HCT. Although the work status among YA HCT survivors continued to improve over time, a substantial subset became or remained unemployed or on medical disability. These findings underscore the need for effective interventions to support return to work in this population.
年轻成人（YA）异体造血细胞移植（HCT）的幸存者有发生晚期心理社会挑战的风险，包括 HCT 后无法重返工作岗位。然而，该人群的工作相关结果仍研究不足。我们进行了这项研究，以评估 YA 异体 HCT 幸存者在 HCT 后 1 年的工作状况，并分析与他们在 HCT 后 1 年工作状况相关的患者、疾病和 HCT 相关因素。使用国际血液和骨髓移植研究中心的数据，我们评估了在 2008 年至 2015 年间接受 HCT 的 1365 名 YA HCT 幸存者在 HCT 后的工作状况（全职、兼职工作、失业或医疗残疾）。在 4 个时间点报告了工作状况类别的百分比：HCT 后 6 个月、1 年、2 年和 3 年。还描述了 1 年时间点的 HCT 后工作状况类别与幸存者 HCT 前工作状况类别的关系。使用逻辑回归分析了与 HCT 后 1 年工作状况（全职或兼职）相关的因素。从 HCT 后 6 个月到 3 年，全职工作的幸存者比例从 18.3%增加到 50.7%，兼职工作的比例从 6.9%增加到 10.5%。在 HCT 前全职工作的患者中，有 50%在 HCT 后 1 年失业或有医疗残疾。女性（比值比[OR]，0.55；95%置信区间[CI]，0.40 至 0.77）、HCT 合并症指数评分≥3（OR，0.57；95%CI，0.39 至 0.82）、HCT 前失业（OR，0.37；95%CI，0.24 至 0.56）、医疗残疾（OR，0.44；95%CI，0.28 至 0.70）、III 级或 IV 级急性移植物抗宿主病（OR，0.52；95%CI，0.34 至 0.80）和 HCT 后 1 年内复发（OR，0.34；95%CI，0.21 至 0.56）与 HCT 后 1 年就业的可能性较低相关。与全身照射（TBI）的清髓性调理相比（MAC），无 TBI 的 MAC（OR，1.71；95%CI，1.16 至 2.53）与 HCT 后 1 年就业的可能性更大相关。研究生教育水平（OR，2.47；95%CI，1.49 至 4.10）也与 HCT 后 1 年就业的可能性更大相关。尽管 YA HCT 幸存者的工作状况随着时间的推移继续改善，但相当一部分人仍然失业或有医疗残疾。这些发现强调需要有效的干预措施来支持该人群重返工作岗位。
