Comparing Psychosocial Profiles and Outcomes between Patients Undergoing Myeloablative and Non-Myeloablative Allogeneic Transplants.

Purpose: The lived experience of patients undergoing myeloablative (allos) compared to non-myeloablative (mini allos) allogeneic BMT is unclear due to a lack of empirical psychosocial studies. This study compares patient characteristics, psychosocial profiles, and outcomes of patients undergoing allos and mini allos.

Methods: From 3/2003 to 12/2005, 125 patients (99 allos and 26 mini allos), completed three psychometric instruments: FACT-BMT (QOL), Brief COPE (coping), and POMS short form (mood states). Patients completed these instruments post discharge for allos and post infusion for mini allos, day 100, 6 months, and 1 year post transplant. P<.05 is utilized to indicate statistical significance.

Results: Relative to allos, mini allos are older (P<.001), married longer (P=.004), have more children (P=.036), are more likely to be retired (P=.025), have more anxiety (P=.039), and a longer interval from diagnosis to transplant (P<.001). Several medical characteristics differ between groups, including diagnosis, preparative regimen, and source of hematopoietic cells. Mini allos engraft faster (P<.001) than allos. Although percentage of patients requiring post-transplant readmission is similar (>85%) between groups, duration of readmission is shorter for mini allos than for allos (median 7 vs.13 days). Outcomes of GVHD, relapse, and survival did not differ significantly between the subgroups; death rate at 1½ year follow-up for allos is 50.5% and for mini allos 42.3%. There are only two baseline differences in psychosocial functioning: social well-being (FACT-QOL) in mini allos is better (P=.014) while planning (COPE) is worse (P=.044). At first post-infusion visit, mini allos have better scores on four FACT-QOL scales: functional well-being (P=.031), additional concerns (P=.019), trial outcome index (P=.010), and total score (P=.046), and worse scores on positive reframing (P=.040). By day 100, minis continue to have better scores on three FACT-QOL scales: additional concerns (P=.012), trial outcome index (P=.013), and total score (P=.031), and worse scores on COPE’s planning scale (P=.034). Due to patient and/or staff omissions in data collection and patient death rates, there are fewer patients who have 6 and 12 month assessments, but among this subset COPE’s use of instrumental support at 6 months is worse for mini allos (P=.029), while positive reframing is worse among mini allos at both 6 months (P=.026) and 12 months (P=.048).

Conclusions: Mini allos have better QOL than allos up to 100 days. However, that QOL returns close to baseline by one year post transplant for surviving patients of both subgroups is encouraging. That mood state scores for both groups are close to baseline at one year, and depression and tension scores are lower suggests a positive outcome. That coping scores for both groups become close to baseline, except for emotional support being used less, indicates return to more independent emotional functioning at one year. The lack of more significant differences between subgroups is surprising. Further analysis of the return to baseline functioning with a larger sample of patients in both subgroups would be of interest.