Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany.
Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology), University Hospital Tübingen, Tübingen, Germany.
Front Immunol. 2024 Oct 24;15:1436639. doi: 10.3389/fimmu.2024.1436639. eCollection 2024.
In severe cases of systemic sclerosis (SSc), autologous hematopoietic stem cell transplantation (aHSCT) is superior compared to cyclophosphamide. But treatment related morbidity and mortality have to be considered. To date, data on major physical and psychological impacts of aHSCT are scarce. Therefore, subjectively experienced physical and psychological impact of aHSCT and exploration of internal and external factors helping to cope with aHSCT was assessed.
Retrospective assessment of physical and psychological variables in an SSc cohort after aHSCT to describe: Health-related quality of life (HRQL), SSc-associated impairment, coping strategies, body image, and resilience. Additionally, semi-structured interviews were conducted and analyzed via mixed methods qualitative content analysis.
Thirty-two patients were included. HRQL correlated with impairment due to SSc and with depressive coping. An unfavorable body image correlated with reduced HRQL and increased impairment but improves after aHSCT. Patients with good resilience had a better HRQL, less depressive coping, and less SSc-associated impairment. The semi-structured interviews revealed that resilience is important for a successful disease management as patients with higher resilience were more satisfied with aHSCT, patients with lower resilience would have wished for more psychological support. Thirty-one patients would recommend aHSCT to other patients.
A transient negative impact of aHSCT on mental well-being is present but can be relieved by a team specialized to aHSCT. Psychological support seems to be an unmet need, particularly in patients with low resilience. Patients with higher resilience described a lower negative impact caused by aHSCT and higher satisfaction after therapy.
在系统性硬化症（SSc）的严重病例中，自体造血干细胞移植（aHSCT）优于环磷酰胺。但是，必须考虑与治疗相关的发病率和死亡率。迄今为止，关于 aHSCT 对主要身体和心理影响的数据很少。因此，评估了 aHSCT 的主观经历的身体和心理影响，并探讨了有助于应对 aHSCT 的内部和外部因素。
对 aHSCT 后 SSc 队列的身体和心理变量进行回顾性评估，以描述：健康相关生活质量（HRQL）、SSc 相关损伤、应对策略、身体形象和适应力。此外，还进行了半结构式访谈，并通过混合方法定性内容分析进行了分析。
共纳入 32 例患者。HRQL 与 SSc 所致损伤和抑郁应对相关。不良的身体形象与较低的 HRQL 和较高的损伤相关，但在 aHSCT 后会改善。具有良好适应力的患者具有更好的 HRQL、较少的抑郁应对和较少的 SSc 相关损伤。半结构式访谈显示，适应力对于成功的疾病管理很重要，因为具有较高适应力的患者对 aHSCT 更满意，适应力较低的患者会希望获得更多的心理支持。31 例患者会向其他患者推荐 aHSCT。
aHSCT 对心理健康有短暂的负面影响，但可以通过专门针对 aHSCT 的团队来缓解。心理支持似乎是一种未满足的需求，尤其是在适应力较低的患者中。适应力较高的患者描述了 aHSCT 造成的负面影响较低，治疗后满意度较高。
