Division of Hemato-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Cancer Res Treat. 2024 Oct;56(4):1262-1269. doi: 10.4143/crt.2024.047. Epub 2024 May 9.
Numerous patients experience long-term complications after hematopoietic stem cell transplantation (HSCT). This study aimed to identify the frequency and risk factors for psychiatric and endocrine complications following HSCT through big data analyses.
We established a cohort of patients with hematologic disease who underwent HSCT in Korea between 2010 and 2012 using the Health Insurance Review & Assessment Service data. A total of 3,636 patients were identified, and insurance claims were tracked using psychiatric and endocrine diagnostic International Classification of Diseases, 10th Revision codes for the ensuing decade. We identified the incidence rates of long-term complications based on the baseline disease and HSCT type. Prognostic factors for each complication were scrutinized using logistic regression analysis.
A total of 1,879 patients underwent allogeneic HSCT and 1,757 patients received autologous HSCT. Post-HSCT, 506 patients were diagnosed with depression, 465 with anxiety disorders, and 659 with diabetes. The highest incidence of long-term complications occurred within the first year post-HSCT (12.2%), subsequently decreasing over time. Risk factors for depressive disorders after allogeneic HSCT included female sex, a total body irradiation-based conditioning regimen, and cyclosporine. Identified risk factors for diabetes mellitus comprised old age, total body irradiation-based conditioning regimen, and non-antithymocyte globulin protocol. Regarding autologous HSCT, only female sex was identified as a risk factor for depressive disorders, whereas elderly patients and those with multiple myeloma were identified as poor prognostic factors for diabetes mellitus.
The incidence of long-term psychiatric and endocrine complications post-HSCT remains high, and patients with risk factors for these complications require vigilant follow-up.
许多患者在造血干细胞移植（HSCT）后会出现长期并发症。本研究旨在通过大数据分析，确定 HSCT 后精神和内分泌并发症的发生频率和危险因素。
我们利用健康保险审查与评估服务数据，建立了一个 2010 年至 2012 年间在韩国接受 HSCT 的血液病患者队列。共确定了 3636 例患者，并使用精神和内分泌疾病的国际疾病分类，第 10 版诊断代码，在随后的十年中跟踪保险索赔。我们根据基础疾病和 HSCT 类型确定了长期并发症的发生率。使用逻辑回归分析对每种并发症的预后因素进行了研究。
共有 1879 例患者接受了异基因 HSCT，1757 例患者接受了自体 HSCT。HSCT 后，506 例患者被诊断为抑郁症，465 例患者被诊断为焦虑症，659 例患者被诊断为糖尿病。长期并发症的最高发生率发生在 HSCT 后 1 年内（12.2%），随后随时间逐渐降低。异基因 HSCT 后发生抑郁障碍的危险因素包括女性、全身照射为基础的预处理方案和环孢素。糖尿病的危险因素包括年龄较大、全身照射为基础的预处理方案和非抗胸腺细胞球蛋白方案。对于自体 HSCT，仅发现女性是发生抑郁障碍的危险因素，而老年患者和多发性骨髓瘤患者是发生糖尿病的不良预后因素。
HSCT 后长期精神和内分泌并发症的发生率仍然很高，有这些并发症危险因素的患者需要密切随访。
