Relative Impact of Psychosocial Factors, Comorbidities, and Disease Risk on the Utilization of Resources and Overall Outcome in Patients Undergoing Hematopoietic Stem Cell Transplantation

Several studies have begun to examine the relationship between psychosocial variables and outcome in hematopoietic stem cell transplantation (HSCT). Previous studies have also looked at the relationship between the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) and overall survival in HSCT which demonstrated a negative relationship between HCT-CI and overall survival. In this study, data was collected on 128 patients undergoing HSCT. Based on the patient’s TERS score, each patient was stratified into one of two groups (low/moderate risk (n=96) vs. high risk (n=32)) based on their predicted psychosocial risk for problems during transplant. Patients were also stratified into two categories on the HCT-CI (low (n= 102) vs. high (n=26)) based on the number of comorbid features present pre-transplant. Patients were also grouped into disease risk categories as classified by the CIBMTR criteria. Only the TERS was found to be a significant predictor of utilization of resources (length of hospitalization) between low/moderate risk (26 days) versus high risk (40 days) patients (p<.02). The HCT-CI (p=.014) and CIBMTR disease risk status (p=.02) were found to be significantly correlated with overall survival. Alone, the TERS showed a similar trend but did not appear to have a significant impact on overall survival. Those patients who scored lowest on all three measures (TERS, HCT-CI and CIBMTR disease risk) had the best overall survival rate, nearing 75% survival at 2 years post HSCT. One would conclude that although psychosocial factors impact the utilization of resources, well equipped transplant centers can provide a relatively safe method for high risk psychosocial patients to undergo HSCT. These results reinforce the impact of the HCT-CI and disease risk on transplant outcome previously found at other large transplant centers.