Table 2 Summary of studies examining QOL... | American Society of Hematology

Table 2

Summary of studies examining QOL after HCT

	QOL index	Patients	Data collected	Time points	Outcomes	Comparator	Special considerations
Syrjala et al 1993²⁹	SIP	HCT, N = 67	Prospective	Baseline, d 90, and 1 y after HCT	Physical functioning impaired by d 90, but returned to pre-HCT levels 68% returned to work Mean levels of anxiety and depression did not change over 1 y	Baseline levels compared with population norms	Pre-HCT family conflict and nonmarried status predicted greater distress at 1 y after HCT Pre-HCT physical impairment, cGVHD, and family conflict predicted impaired physical recovery at 1 y
Kopp et al 1998⁹⁸	FACT BMT and EORTC QLQ C30	HCT, N = 56	Prospective	1y, 2y	Reduced QOL at 1y, improved by 2y	None
McQuellon et al 1998²³	FACT-BMT	HCT, N = 86	Prospective	Baseline, hospital discharge, d 100, 1y	Overall QOL trend parabolic; worsened by discharge, then improved by d100 and 1y	None	Linear improvement in distress; 20% at 1y Patient concerns worsen over time points
Hjermstad et al 1999⁶¹	EORTC QLQ-C30	HCT, N = 177	Prospective	1 y after HCT	Significantly worse social, role function, appetite loss, financial difficulty, cognition, physical role	Reference data from general population sample
Uses a subset of the Hjermstad et al 1999¹⁶	EORTC QLQ-C30	HCT and chemo SCT, n = 41; ASCT, n = 51; CT, n = 85	Prospective	Baseline, 1 y after HCT	Baseline QOL significantly better for allo HCT group compared with auto HCT and CT group Different trend at 1 y, w/ auto HCT and CT improving, although no significant change in allo HCT group	HCT group compared with chemo group as control
Bush et al 2000²⁶	EORTC QLQ C30	HCT, N = 415	Prospective	Annual, 1 y through 4 y	Low/moderate severity of BMT related symptoms overall Improvements in QOL over 4 y follow up	None
Lee et al 2001²²	Questionnaires developed for the study	HCT, N = 320	Prospective	Baseline, 6, 12, 24 mo	Overall, <24% reported bothersome symptoms 60% report recovery by 1-2 y	Auto and allo HCT	More complete recovery in Auto HCT group at 6 mo, but equalized by 12 mo
Díez-Campelo et al 2004⁵⁷	FACT-BMT	RIC Allo HCT, N = 47	Prospective	D 7, 14, 21, 90, 180, 270, 360	RIC Allo HCT scores significantly better compared with auto HCT early in course	Comparison group of auto HCT
Hjermstad et al 2004¹⁷	EORTC-QLQ-C30	HCT, and chemo SCT, n = 61; ASCT, n = 69; CT, n = 118	Prospective	3-5 y after HCT	Allo group reported improvement in overall QOL from 1 y to 3-5 y, worse role functioning and fatigue than population norms	Reference data from general population sample	Hjermstad et al 1999¹⁶
Syrjala et al 2004²	SIP	HCT, N = 319	Prospective	Pre-HCT, d 90; 1, 3, 5 y	Proportion without major limitations 63% by 5 y 84% returned to work by 5y	Auto and allo HCT
Bevans et al 2006²⁴	SF-36, and FACT-BMT	Allo HCT (ablative vs RIC), n = 41 (RIC), n = 35 (ablative)	Prospective	Baseline, d 0, 30, 100, 1 y, 2 y	HRQL progressively improved (P<.01) in both groups with higher scores at d 100 compared with d 0 and 30 No difference between groups At 2 y, all survivors (n = 43) reported HRQL similar or better than baseline	Ablative vs RIC allo HCT
Lee et al 2006⁸	FACT-BMT	Allo HCT, N = 96	Prospective	Baseline, 6 mo, 12 mo	(TOI) of FACT-BMT sensitive to acute or chronic GVHD GVHD is a major determinant of the long-term QOL of survivors Adverse effects of acute GVHD detectable with TOI at 6 mo after transplantation after which development of chronic GVHD is the most strongly correlated with worse QOL	None
Wettergren et al 2008⁶⁵	QLQ-C30	HCT, N = 22	Prospective	Baseline, 1y after HCT	Concerns related to health before as well as 1 y after SCT Change over time, indicating improved quality of life 1 y after SCT Comparison with Swedish norm values for the EORTC QLQ-C30, SCT recipients reported a worse functioning	Swedish norm values (for QLQ-C30)	Included positive aspects, eg, a changed view of life and oneself
Baker et al 1991⁹⁹	SLDS	HCT, N = 135	Cross-sectional	Single measure, > 6 mo after HCT	Role retention significantly correlated w/ quality of life	None
Wingard et al 1991⁸³	Health perception scale	HCT, N = 135	Cross-sectional	Single measure, mean 47 mo after HCT	Global health ″good to excellent″ in 67% 65% returned to work	None
Schmidt et al 1993⁸⁴	COH-QOL	HCT, N = 212	Cross-sectional	Single measure	Majority self-report 8 or greater on scale of 1–10	None	Nonsignificantly better QOL scores in <18-year-old group vs >18-year-old group
Baker et al 1994⁴⁸	SLDS	HCT, N = 135	Cross-sectional	Single measure, 6-149 mo after HCT	Global health ″good to excellent″ in 67% Greater positive and negative affect compared with general population norm	General population comparator	Identified several predictors of QOL: self-esteem, physical functioning, social support, graft vs host disease
Litwins et al 1994³⁹	SIP	HCT, N = 32	Cross-sectional	Single measure, > 1y after treatment	No significant differences between HCT and chemotherapy	HCT (n = 32) vs chemotherapy (n = 22)
Andrykowski et al 1995⁵⁸	SIP, ROF, PHQ, PQOL, SER	HCT, N = 200	Cross-sectional	Single measure, mean 43 mo	QOL worse in Allo-HCT compared with Auto-HCT	Allo vs auto HCT	Predictors of reduced QOL: greater age at BMT, lower education, advanced disease at BMT
Bush et al 1995⁵²	EORTC QLQ C-30	HCT, N = 125	Cross-sectional	6-18 y after HCT (mean 10 y)	74% self-report QOL same or better than pre-HCT levels 80% rate current QOL as ″good to excellent″	Cancer and population norms	88% state benefit of HCT outweigh the risks
Molassiotis et al 1995³⁸	RSCL	Allo HCT, N =50	Cross-sectional	Mean 42.4 mo after HCT	QOL as ″good to excellent″ in most patients One-fourth failed to return to work/education No significant differences between allo HCT and auto HCT	Allo HCT vs Auto HCT	Physical symptoms, adjustment to vocational environment, and depression were predictors for QOL
Molassiotis et al 1996³⁷	RSCL, PSFQ	HCT, N = 91	Cross-sectional	Mean 39.8 mo after HCT	79.6% report ″good to excellent″ QOL; no significant difference between HCT and chemotherapy group	HCT (n = 91) vs chemotherapy (n = 73)
Prieto et al 1996⁴⁰	NHP, GHQ	HCT, N = 117	Cross-sectional	Single assessment, median 55 mo	HCT: decrement in QOL in physical mobility, work, and sex life HCT: psychiatric morbidity higher	British reference population Spanish general population	Multivariate analyses: higher systemic symptom score, lower educational level, older age, shorter time after BMT, female sex, and impotence significant predictors of impaired overall QOL
Wellisch et al 1996⁴²	CARES	Allo-HCT for AML, N = 30	Cross-sectional	Single measure 5-6.5 y after therapy	No significant differences in QOL comparing HCT and chemotherapy	Consolidation chemotherapy
Sutherland et al 1997⁴⁹	SF-36, SLDS-BMT	Allo HCT, N = 231	Cross-sectional	Single assessment, median 40 mo	Significant decrement in QOL in all measures in HCT group Those >3y after HCT had scores equivalent to or better than population norms	Age adjusted population norms
Zittoun et al 1997³⁵	EORTC QLQ C30	Allo vs auto vs chemo in AML in CR1, N = 98	Cross-sectional	Single measure, median time 53 mo after CR	Significantly lower QOL scores (allogeneic < autologous < chemotherapy)	Examined allo HCT vs auto vs after remission chemotherapy
Edman et al 2001⁵¹	SIP	Allo HCT, N = 25	Cross-sectional	Single measure, 2-4 y after HCT	Significant impairment in QOL compared with population norms No difference in sense of coherence	Swedish population norms	Despite impairments, 80% report general health good or excellent
Heinonen et al 2001¹⁰⁰	FACT-BMT	Allo HCT, N = 109	Cross-sectional	Single measure, minimum follow up 4 mo	No significant differences between males and females in overall physical, functional, and social well-being by the FACT-BMT	Compared men with women in study sample	Females reported worse emotional well-being, fatigue, less quality sleep Males reported less satisfaction with social support, more sexually active
Kiss et al 2002⁴⁷	MOS-SF36, SLDS-BMT	Allo HCT in CML, N = 89	Cross-sectional	10 y after HCT	Significant reductions in physical functioning and general health	US normative population	cGVHD significant predictor of QOL
Worel et al 2002⁵⁵	EORTC QLQ-C30	Allo or syngeneic HCT, N = 106	Cross-sectional	Single measure, >2y after HCT	Demonstrated significant worsening in QLQ-C30 scores for those with cGVHD (compared with those without)	None
Wong et al 2003⁵⁶	FACT-BMT	RIC Allo HCT, N = 9	Cross-sectional	Single measure, median of 495 to 910 d after HCT	Reported good QOL, median FACT-BMT score 147.19	None
Hayden et al 2004⁵⁰	EORTC QLQ-C30	Allo HCT in CML, N = 46	Cross-sectional	Single measure, median 98 mo	No difference in the Physical, Emotional and Social domains or overall Global Health Status/QOL-scores significantly lower for role, cognitive function	Age adjusted general population	Significant increase in dyspnea, and financial difficulties Decreased sexual functioning
Andrykowski et al 2005²⁰	SF-36	HCT, N = 662	Cross-sectional	Single measure mean 7y after HCT	HCT group: significantly worse physical health, physical functioning, social functioning, psychologic adjustment, and dyadic adjustment	Healthy age, sex matched controls, n = 158	HCT group had more psychologic and interpersonal growth
Kopp et al 2005⁴⁴	EORTC-QLQ C30	HCT, N = 34	Cross-sectional	Single measure (>5y after HCT)	Significantly lower QOL on the dimensions of physical and social functioning and on the financial impact symptom scale	68 age, sex, race matched healthy controls
Syrjala et al 2005⁴⁵	SF-36	Allo HCT, N = 137(supp)	Cross-sectional	Single measure at 10y after HCT	Worse social function (P = .002), emotional (P = .007) and physical (P = .004) limitations, lower vitality scale (P = .017) Those with musculoskeletal problems reported more bodily pain (P < .001) and fatigue (P < .001)	137 age-, sex-, race-matched controls
Fraser et al 2006⁵⁴	BMT-SS	Allo HCT, N = 584	Cross-sectional	Single measure (>2y after HCT)	Active cGVHD significantly associated with worse QOL Affected general health, mental health, functional impairments, activity limitation, and pain	Resolved chronic GVHD or no history of chronic GVHD
Messerer et al 2008⁴¹	EORTC QLQ-C30	HCT vs CT in AML, N = 419	Cross-sectional	Single measure, median 8y	All QLQ-C30 functions, except physical functioning and pain, were poorer in allo HCT compared with CT	Compared HCT with chemotherapy in AML

	QOL index	Patients	Data collected	Time points	Outcomes	Comparator	Special considerations
Syrjala et al 1993²⁹	SIP	HCT, N = 67	Prospective	Baseline, d 90, and 1 y after HCT	Physical functioning impaired by d 90, but returned to pre-HCT levels 68% returned to work Mean levels of anxiety and depression did not change over 1 y	Baseline levels compared with population norms	Pre-HCT family conflict and nonmarried status predicted greater distress at 1 y after HCT Pre-HCT physical impairment, cGVHD, and family conflict predicted impaired physical recovery at 1 y
Kopp et al 1998⁹⁸	FACT BMT and EORTC QLQ C30	HCT, N = 56	Prospective	1y, 2y	Reduced QOL at 1y, improved by 2y	None
McQuellon et al 1998²³	FACT-BMT	HCT, N = 86	Prospective	Baseline, hospital discharge, d 100, 1y	Overall QOL trend parabolic; worsened by discharge, then improved by d100 and 1y	None	Linear improvement in distress; 20% at 1y Patient concerns worsen over time points
Hjermstad et al 1999⁶¹	EORTC QLQ-C30	HCT, N = 177	Prospective	1 y after HCT	Significantly worse social, role function, appetite loss, financial difficulty, cognition, physical role	Reference data from general population sample
Uses a subset of the Hjermstad et al 1999¹⁶	EORTC QLQ-C30	HCT and chemo SCT, n = 41; ASCT, n = 51; CT, n = 85	Prospective	Baseline, 1 y after HCT	Baseline QOL significantly better for allo HCT group compared with auto HCT and CT group Different trend at 1 y, w/ auto HCT and CT improving, although no significant change in allo HCT group	HCT group compared with chemo group as control
Bush et al 2000²⁶	EORTC QLQ C30	HCT, N = 415	Prospective	Annual, 1 y through 4 y	Low/moderate severity of BMT related symptoms overall Improvements in QOL over 4 y follow up	None
Lee et al 2001²²	Questionnaires developed for the study	HCT, N = 320	Prospective	Baseline, 6, 12, 24 mo	Overall, <24% reported bothersome symptoms 60% report recovery by 1-2 y	Auto and allo HCT	More complete recovery in Auto HCT group at 6 mo, but equalized by 12 mo
Díez-Campelo et al 2004⁵⁷	FACT-BMT	RIC Allo HCT, N = 47	Prospective	D 7, 14, 21, 90, 180, 270, 360	RIC Allo HCT scores significantly better compared with auto HCT early in course	Comparison group of auto HCT
Hjermstad et al 2004¹⁷	EORTC-QLQ-C30	HCT, and chemo SCT, n = 61; ASCT, n = 69; CT, n = 118	Prospective	3-5 y after HCT	Allo group reported improvement in overall QOL from 1 y to 3-5 y, worse role functioning and fatigue than population norms	Reference data from general population sample	Hjermstad et al 1999¹⁶
Syrjala et al 2004²	SIP	HCT, N = 319	Prospective	Pre-HCT, d 90; 1, 3, 5 y	Proportion without major limitations 63% by 5 y 84% returned to work by 5y	Auto and allo HCT
Bevans et al 2006²⁴	SF-36, and FACT-BMT	Allo HCT (ablative vs RIC), n = 41 (RIC), n = 35 (ablative)	Prospective	Baseline, d 0, 30, 100, 1 y, 2 y	HRQL progressively improved (P<.01) in both groups with higher scores at d 100 compared with d 0 and 30 No difference between groups At 2 y, all survivors (n = 43) reported HRQL similar or better than baseline	Ablative vs RIC allo HCT
Lee et al 2006⁸	FACT-BMT	Allo HCT, N = 96	Prospective	Baseline, 6 mo, 12 mo	(TOI) of FACT-BMT sensitive to acute or chronic GVHD GVHD is a major determinant of the long-term QOL of survivors Adverse effects of acute GVHD detectable with TOI at 6 mo after transplantation after which development of chronic GVHD is the most strongly correlated with worse QOL	None
Wettergren et al 2008⁶⁵	QLQ-C30	HCT, N = 22	Prospective	Baseline, 1y after HCT	Concerns related to health before as well as 1 y after SCT Change over time, indicating improved quality of life 1 y after SCT Comparison with Swedish norm values for the EORTC QLQ-C30, SCT recipients reported a worse functioning	Swedish norm values (for QLQ-C30)	Included positive aspects, eg, a changed view of life and oneself
Baker et al 1991⁹⁹	SLDS	HCT, N = 135	Cross-sectional	Single measure, > 6 mo after HCT	Role retention significantly correlated w/ quality of life	None
Wingard et al 1991⁸³	Health perception scale	HCT, N = 135	Cross-sectional	Single measure, mean 47 mo after HCT	Global health ″good to excellent″ in 67% 65% returned to work	None
Schmidt et al 1993⁸⁴	COH-QOL	HCT, N = 212	Cross-sectional	Single measure	Majority self-report 8 or greater on scale of 1–10	None	Nonsignificantly better QOL scores in <18-year-old group vs >18-year-old group
Baker et al 1994⁴⁸	SLDS	HCT, N = 135	Cross-sectional	Single measure, 6-149 mo after HCT	Global health ″good to excellent″ in 67% Greater positive and negative affect compared with general population norm	General population comparator	Identified several predictors of QOL: self-esteem, physical functioning, social support, graft vs host disease
Litwins et al 1994³⁹	SIP	HCT, N = 32	Cross-sectional	Single measure, > 1y after treatment	No significant differences between HCT and chemotherapy	HCT (n = 32) vs chemotherapy (n = 22)
Andrykowski et al 1995⁵⁸	SIP, ROF, PHQ, PQOL, SER	HCT, N = 200	Cross-sectional	Single measure, mean 43 mo	QOL worse in Allo-HCT compared with Auto-HCT	Allo vs auto HCT	Predictors of reduced QOL: greater age at BMT, lower education, advanced disease at BMT
Bush et al 1995⁵²	EORTC QLQ C-30	HCT, N = 125	Cross-sectional	6-18 y after HCT (mean 10 y)	74% self-report QOL same or better than pre-HCT levels 80% rate current QOL as ″good to excellent″	Cancer and population norms	88% state benefit of HCT outweigh the risks
Molassiotis et al 1995³⁸	RSCL	Allo HCT, N =50	Cross-sectional	Mean 42.4 mo after HCT	QOL as ″good to excellent″ in most patients One-fourth failed to return to work/education No significant differences between allo HCT and auto HCT	Allo HCT vs Auto HCT	Physical symptoms, adjustment to vocational environment, and depression were predictors for QOL
Molassiotis et al 1996³⁷	RSCL, PSFQ	HCT, N = 91	Cross-sectional	Mean 39.8 mo after HCT	79.6% report ″good to excellent″ QOL; no significant difference between HCT and chemotherapy group	HCT (n = 91) vs chemotherapy (n = 73)
Prieto et al 1996⁴⁰	NHP, GHQ	HCT, N = 117	Cross-sectional	Single assessment, median 55 mo	HCT: decrement in QOL in physical mobility, work, and sex life HCT: psychiatric morbidity higher	British reference population Spanish general population	Multivariate analyses: higher systemic symptom score, lower educational level, older age, shorter time after BMT, female sex, and impotence significant predictors of impaired overall QOL
Wellisch et al 1996⁴²	CARES	Allo-HCT for AML, N = 30	Cross-sectional	Single measure 5-6.5 y after therapy	No significant differences in QOL comparing HCT and chemotherapy	Consolidation chemotherapy
Sutherland et al 1997⁴⁹	SF-36, SLDS-BMT	Allo HCT, N = 231	Cross-sectional	Single assessment, median 40 mo	Significant decrement in QOL in all measures in HCT group Those >3y after HCT had scores equivalent to or better than population norms	Age adjusted population norms
Zittoun et al 1997³⁵	EORTC QLQ C30	Allo vs auto vs chemo in AML in CR1, N = 98	Cross-sectional	Single measure, median time 53 mo after CR	Significantly lower QOL scores (allogeneic < autologous < chemotherapy)	Examined allo HCT vs auto vs after remission chemotherapy
Edman et al 2001⁵¹	SIP	Allo HCT, N = 25	Cross-sectional	Single measure, 2-4 y after HCT	Significant impairment in QOL compared with population norms No difference in sense of coherence	Swedish population norms	Despite impairments, 80% report general health good or excellent
Heinonen et al 2001¹⁰⁰	FACT-BMT	Allo HCT, N = 109	Cross-sectional	Single measure, minimum follow up 4 mo	No significant differences between males and females in overall physical, functional, and social well-being by the FACT-BMT	Compared men with women in study sample	Females reported worse emotional well-being, fatigue, less quality sleep Males reported less satisfaction with social support, more sexually active
Kiss et al 2002⁴⁷	MOS-SF36, SLDS-BMT	Allo HCT in CML, N = 89	Cross-sectional	10 y after HCT	Significant reductions in physical functioning and general health	US normative population	cGVHD significant predictor of QOL
Worel et al 2002⁵⁵	EORTC QLQ-C30	Allo or syngeneic HCT, N = 106	Cross-sectional	Single measure, >2y after HCT	Demonstrated significant worsening in QLQ-C30 scores for those with cGVHD (compared with those without)	None
Wong et al 2003⁵⁶	FACT-BMT	RIC Allo HCT, N = 9	Cross-sectional	Single measure, median of 495 to 910 d after HCT	Reported good QOL, median FACT-BMT score 147.19	None
Hayden et al 2004⁵⁰	EORTC QLQ-C30	Allo HCT in CML, N = 46	Cross-sectional	Single measure, median 98 mo	No difference in the Physical, Emotional and Social domains or overall Global Health Status/QOL-scores significantly lower for role, cognitive function	Age adjusted general population	Significant increase in dyspnea, and financial difficulties Decreased sexual functioning
Andrykowski et al 2005²⁰	SF-36	HCT, N = 662	Cross-sectional	Single measure mean 7y after HCT	HCT group: significantly worse physical health, physical functioning, social functioning, psychologic adjustment, and dyadic adjustment	Healthy age, sex matched controls, n = 158	HCT group had more psychologic and interpersonal growth
Kopp et al 2005⁴⁴	EORTC-QLQ C30	HCT, N = 34	Cross-sectional	Single measure (>5y after HCT)	Significantly lower QOL on the dimensions of physical and social functioning and on the financial impact symptom scale	68 age, sex, race matched healthy controls
Syrjala et al 2005⁴⁵	SF-36	Allo HCT, N = 137(supp)	Cross-sectional	Single measure at 10y after HCT	Worse social function (P = .002), emotional (P = .007) and physical (P = .004) limitations, lower vitality scale (P = .017) Those with musculoskeletal problems reported more bodily pain (P < .001) and fatigue (P < .001)	137 age-, sex-, race-matched controls
Fraser et al 2006⁵⁴	BMT-SS	Allo HCT, N = 584	Cross-sectional	Single measure (>2y after HCT)	Active cGVHD significantly associated with worse QOL Affected general health, mental health, functional impairments, activity limitation, and pain	Resolved chronic GVHD or no history of chronic GVHD
Messerer et al 2008⁴¹	EORTC QLQ-C30	HCT vs CT in AML, N = 419	Cross-sectional	Single measure, median 8y	All QLQ-C30 functions, except physical functioning and pain, were poorer in allo HCT compared with CT	Compared HCT with chemotherapy in AML

HCT indicates hematopoietic cell transplantation (composite of allogeneic and autologous transplantation); auto HCT, autologous hematopoietic cell transplantation; allo HCT, allogeneic hematopoietic cell transplantation; RIC, reduced intensity conditioning regimen; CT, chemotherapy; and AML, acute myeloid leukemia.

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