Long-Term Survival and Quality of Life Analysis after Autologous Stem Cell Transplantation for Lymphoma

Background

Autologous stem cell transplantation (ASCT) is a frequent treatment option for various types of lymphoma. Few studies have addressed the occurrence of long-term morbidity and the quality of life (QoL) after ASCT. We analysed the overall survival (OS), the QoL and the impact of comorbidities before and after transplant in a consecutive cohort of lymphoma patients.

Methods

Patients transplanted in our center between 2003 and 2013 and with a minimum follow-up of 1 year were included. Survival was analysed by Kaplan-Meier methodology and the impact of prognostic factors was examined by standard multivariate analysis. Patients were inquired to complete the Self-reported Comorbidity Questionnaire (SCQ) as well as the EORTC QLQ-C30. Results of questionnaires were compared to a healthy reference population.

Results

A total of 85 lymphoma patients were identified with a median follow-up period of 76 months. The estimated OS probability was 62,7% (S.E. 5,5%) at 5 years and 60,8% (S.E. 5,6%) at 10,9 years. Indicators of a poor prognosis at time of transplantation were: age ≥ 60 years, high-intermediate to high-risk IPI for NHL and HCT-comorbidity index ≥ 3. Of long-term (> 1 year) survivors 40 completed the EORTC QLQ-C30. They experienced lower cognitive and social functioning and reported more fatigue, dyspnea and financial difficulties, when compared to the reference population. A small proportion of patients reported significant complaints related to pain (22,5%) and fatigue (10%). Very long-term survivors (over 5 years post ASCT) had a better physical and role functioning, with less fatigue, dyspnea, insomnia and loss of appetite as compared to patients who were transplanted more recently. Patients with more self-reported comorbidities post-ASCT did significantly worse in terms of QoL after transplantation. They experienced worse physical, role, cognitive and social functioning, and had more complaints about fatigue, pain, dyspnea, diarrhea and insomnia.

Conclusion

The presence of comorbidities pre-ASCT, as determined by HCT-CI >3, was associated with a worse OS. Surprisingly, the overall long-term impact of ASCT on the QOL was limited with adverse effects only related to cognitive and social functions. These negative consequences also decreased over time. Finally, the occurrence of comorbidities after transplantation was associated with worse QoL.