Factors Affecting Quality of Life During and After Stem Cell Transplantation in Long Term Survivors – Comparison of Autologous and Allogeneic Stem Cell Transplantation

Myeloblative conditioning (MAC) or reduced intensity conditioning (RIC) followed by autologous or allogeneic stem cell transplantation (ASCT or AlloSCT) is established and lifesaving treatment in selected indications. The quality of life (QoL) is then very important issue for long term surviving patients. The majority of data is often based on single center evaluation with limited number of patients. Therefore we have started the cross-sectional QoL project and this analysis is based on data collected from eight transplant centers.

Altogether data from 1399 patients are included in the study. The FACT-G questionnaire (Q) was used for this analysis. The questionnaire consists of four parts - physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB). The patients completed the Q before the transplantation (at the time of indication or at the time of admission to SCT) n=304, after ASCT n=662 and after AlloSCT n=433. Patients were divided into 7 groups – before SCT, day +100, up to 1y, 1–2y, 2–3y, 3–5y and more than 5y. The clinical characteristics were obtained from national transplant registry; the data was cleaned and updated. Wilcoxon and Kruskall-Wallis tests were used for statistical analysis.

The ASCT and AlloSCT groups (grp.) consist of 869 and 530 pts resp. including 207 pts before ASCT and 97 before AlloSCT. There were 52.8% and 55.7% men in ASCT and AlloSCT grp. resp. The median age in ASCT and AlloSCT grp. resp. was: 55.2 and 43.2y resp., the median follow-up 4.4 and 4.5y resp. The most frequent diagnosis of ASCT group were: Non-Hodgkin′s lymphoma (NHL) 46.1%, multiple myeloma (MM) 36.6%, Hodgkin′s lymphoma (HL) 8.5%. In AlloSCT: acute myelogenous leukemia 29.4%, acute lymphoblastic leukemia 15.7%, chronic myeloid leukemia 11.5% and myelodysplastic syndrome 10.0%. Disease progression/relapse was observed in 148 ASCT (22.4%) and 61 AlloSCT (14.1%) pts. In AlloSCT group MAC was used in 33% pts and matched unrelated donor (MUD) in 59.8% pts., aGVHD gr I-II was observed in 40.3% and gr III-IV 4.2% pts, cGVHD in 37.9% pts.

Significant differences in overall QoL before, during and after the AlloSCT (p<0.001) and ASCT (p=0.01) were observed. The QoL was improved from 1y after ASCT as well as from 2y after Allo-SCT. It was due mainly to the PWB and FWB improvement in both SCT groups, SWB and EWB remained unchanged. Long term survivors reported better QoL vs pts before transplant both in the alloSCT gr. (89 vs 80.7 points) as well as in ASCT gr.(82 vs 73.1). Interestingly, significantly better QoL in AlloSCT vs ASCT gr. was reported in all time points except day +100 and 2y. At the time of indication it was 80.7 vs 73.1 (p=0.035) and the most significant difference was among long-term survivors 89.0 vs 82.0 (p<0.001). The overall QoL was not affected by gender, women only reported better SWB in AlloSCT and ASCT grp. and men reported better EWB in ASCT gr. The age had significant impact on overall QoL in ASCT (p=0.005) and AlloSCT (p=0.006) but only due to difference in PWB and FWB resp., which was more profound in AlloSCT (p<0.001). The diagnosis had no impact on QoL in AlloSCT grp. but the MM pts have significantly lower QoL compared to NHL and HL pts. resp. (73 vs 80 vs 82 resp. p<0.001) in ASCT group. There was no significant impact of MAC or RIC on the QoL, patients with MUD has lower QoL compared to sibling donor (84.8 vs 88, p<0.05). Relapse after transplantation was associated with worse QoL, after ASCT 74 vs 81 (p=0.02) and after AlloSCT 81.5 vs 87.5 (borderline significance p =0.065). The long term survivor′s QoL was not affected by aGVHD in contrast to the cGVHD which significantly affects QoL (p<0.001) due to lower PWB (p<0.001) and FWB (p<0.001).

We herein demostrate on large cohorts of pts that long term survivors have significantly better QoL compared to QoL in the time of indication of the transplantation and the improvement starts from 1y after ASCT and from 2y after AlloSCT. AlloSCT survivors report better QoL compared to the ASCT survivors. The most important factors affected QoL are age, cGVHD (AlloSCT) and diagnosis (ASCT), the borderline factors are relapse after SCT and type of donor (AlloSCT).

No relevant conflicts of interest to declare.